Healthcare Provider Details

I. General information

NPI: 1205574829
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS COLORADO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S MAIN ST STE B
LONGMONT CO
80501-1714
US

IV. Provider business mailing address

PO BOX 32517
BELFAST ME
04915-0218
US

V. Phone/Fax

Practice location:
  • Phone: 302-772-6244
  • Fax:
Mailing address:
  • Phone: 844-969-0686
  • Fax: 866-825-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RAGER
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 844-969-0686