Healthcare Provider Details

I. General information

NPI: 1124611652
Provider Name (Legal Business Name): ROCKY MOUNTAIN VEIN INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9461 HURON ST
THORNTON CO
80260-5426
US

IV. Provider business mailing address

PO BOX 7702
LOVELAND CO
80537-0702
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-3092
  • Fax: 719-545-1829
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-342-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: GORDON F GIBBS
Title or Position: OWNER
Credential:
Phone: 719-543-8346