Healthcare Provider Details

I. General information

NPI: 1669461281
Provider Name (Legal Business Name): INTERMOUNTAIN FRONT RANGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 W 40TH AVE
WHEAT RIDGE CO
80401-2696
US

IV. Provider business mailing address

12911 W 40TH AVE
WHEAT RIDGE CO
80401-2696
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-4500
  • Fax:
Mailing address:
  • Phone: 303-425-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0083
License Number StateCO

VIII. Authorized Official

Name: ASHLEY DENTON
Title or Position: VP OF FINANCE
Credential:
Phone: 303-425-2410