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General NPI Number Information
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NPI Number | 1730747445
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Entity Type | Organization
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Legal Business Name | COLORADO MOUNTAIN MEDICAL, LLC
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 50 BUCK CREEK RD STE 200
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City | AVON
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State | CO
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Zip | 81620-5444
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Country | US
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Telephone | 970-926-6340
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Fax | 970-926-6348
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Provider Business Mailing Address
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Address Line | PO BOX 4330
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City | AVON
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State | CO
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Zip | 81620-4330
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Country | US
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Telephone | 970-845-2903
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DIANE VOYTKO
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Credential |
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Telephone | 970-926-6340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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