=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669461281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERMOUNTAIN FRONT RANGE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2005
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12911 W 40TH AVE
-----------------------------------------------------
City | WHEAT RIDGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-2696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-425-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12911 W 40TH AVE
-----------------------------------------------------
City | WHEAT RIDGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-2696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-425-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE
-----------------------------------------------------
Name | ASHLEY DENTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-425-2410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 0083
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------