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General NPI Number Information
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NPI Number | 1992109243
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN HEALTH CENTER, LLC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 1465 KELLY JOHNSON BLVD SUITE 100-D
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3955
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Country | US
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Telephone | 719-522-4442
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Fax | 719-522-4442
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Provider Business Mailing Address
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Address Line | 1465 KELLY JOHNSON BLVD SUITE 100-D
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3955
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Country | US
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Telephone | 719-522-4442
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Fax | 719-522-4442
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARVIN L SWANSON
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Credential | MD
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Telephone | 719-522-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | DR0018703
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License Number State | CO
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