=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578724340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCKY MOUNTAIN FAMILY MEDICAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2008
-----------------------------------------------------
Last Update Date | 08/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 STAFFORD LN
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-2282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-399-2880
-----------------------------------------------------
Fax | 970-399-2848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 STAFFORD LN
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-2282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-399-2880
-----------------------------------------------------
Fax | 970-399-2848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROBERT EUGENE BELL
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 970-399-2880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 46365
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------