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General NPI Number Information
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NPI Number | 1144524760
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Entity Type | Organization
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Legal Business Name | INNER MOUNTAIN PSYCHIATRY, INC.
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 1905 AIRPORT ROAD
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-8498
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Country | US
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Telephone | 970-485-5369
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8498
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City | BRECKENRIDGE
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State | CO
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Zip | 80424-8498
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Country | US
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Telephone | 970-485-5369
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM PAUL ELSASS
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Credential | MD
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Telephone | 970-485-5369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 45646
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License Number State | CO
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