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General NPI Number Information
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NPI Number | 1811999758
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Entity Type | Organization
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Legal Business Name | HEART CENTER OF THE ROCKIES CATH LAB LLC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 2500 ROCKY MOUNTAIN AVE
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City | LOVELAND
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State | CO
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Zip | 80538
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Country | US
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Telephone | 970-624-1756
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Fax | 970-624-1792
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Provider Business Mailing Address
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Address Line | 2121 E HARMONY RD STE 100
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City | FORT COLLINS
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State | CO
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Zip | 80528-3400
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Country | US
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Telephone | 970-297-6866
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Fax | 970-297-6862
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DALE RICHARDSON
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Credential |
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Telephone | 970-297-6931
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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 | 31863
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 31863
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License Number State | CO
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