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General NPI Number Information
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NPI Number | 1437768124
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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 | 07/28/2020
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 3655 LUTHERAN PKWY STE 201
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6010
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Country | US
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Telephone | 303-603-9800
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Fax | 303-403-6209
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Provider Business Mailing Address
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Address Line | 500 ELDORADO BLVD STE 6300
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City | BROOMFIELD
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State | CO
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Zip | 80021-3422
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Country | US
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Telephone | 303-272-0566
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Fax | 303-272-0390
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Authorized Official
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Title or Position | VP FINANCE MGPS OPERATIONS
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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