Healthcare Provider Details

I. General information

NPI: 1801473251
Provider Name (Legal Business Name): ENT SPECIALISTS OF THE ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 PARK MEADOWS DR STE 200
LONE TREE CO
80124-8406
US

IV. Provider business mailing address

850 E HARVARD AVE STE 505
DENVER CO
80210-5078
US

V. Phone/Fax

Practice location:
  • Phone: 720-897-7160
  • Fax:
Mailing address:
  • Phone: 720-897-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA SKINNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-673-7175