=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548466535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLORADO SLEEP CENTER OF THE ROCKIES,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 ROCKY MOUNTAIN AVE SUITE 3100
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-631-1041
-----------------------------------------------------
Fax | 308-630-1657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 ROCKY MOUNTAIN AVE SUITE 3100
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-631-1041
-----------------------------------------------------
Fax | 308-630-1657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. TERRY MARK HIMES
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 308-631-1041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 41631
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------