Healthcare Provider Details

I. General information

NPI: 1225559339
Provider Name (Legal Business Name): NEUROLOGY SPECIALISTS OF THE ROCKIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 BLUEGRASS CIR
CHEYENNE WY
82009-7329
US

IV. Provider business mailing address

2003 BLUEGRASS CIR
CHEYENNE WY
82009-7329
US

V. Phone/Fax

Practice location:
  • Phone: 307-287-0867
  • Fax: 307-635-1875
Mailing address:
  • Phone: 307-287-0867
  • Fax: 307-635-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number6318A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY JAY ALLEN
Title or Position: OWNER
Credential: MD
Phone: 307-432-3924