Healthcare Provider Details

I. General information

NPI: 1144547191
Provider Name (Legal Business Name): ROCKY MOUNTAIN VEIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 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: 719-546-6236
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 Number45004
License Number StateCO

VIII. Authorized Official

Name: GORDON FABING GIBBS
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 719-543-8346