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General NPI Number Information
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NPI Number | 1073332557
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Entity Type | Organization
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Legal Business Name | ROYAL GORGE PSYCHIATRY
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 129 SAVAGE LOOP
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City | CANON CITY
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State | CO
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Zip | 81212-4185
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Country | US
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Telephone | 720-467-9478
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 MAIN STREET PO BOX 102
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City | CANON CITY
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State | CO
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Zip | 81212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. KARL JAMES WEBER
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Credential | NP
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Telephone | 719-420-0238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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