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General NPI Number Information
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NPI Number | 1083598874
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 1830 N FRANKLIN ST STE 400
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City | DENVER
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State | CO
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Zip | 80218-1128
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Country | US
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Telephone | 720-689-9350
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Fax | 720-689-5201
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Provider Business Mailing Address
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Address Line | 500 ELDORADO BLVD STE 4300
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City | BROOMFIELD
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State | CO
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Zip | 80021-3564
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Country | US
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Telephone | 303-272-0566
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Fax |
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Authorized Official
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Title or Position | VP FINANCE
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Name | JON MCDANIEL
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Credential |
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Telephone | 303-272-0231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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