=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982874665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCKY MOUNTAIN MEDICAL PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 11/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2038 CARIBOU DR SUITE 201
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-494-0804
-----------------------------------------------------
Fax | 970-377-8766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2038 CARIBOU DIVE SUITE 201
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-494-0804
-----------------------------------------------------
Fax | 970-377-8766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CLIFFORD LORIN ZELLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 970-494-0804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | DR18448
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------