MEDICARE: ROYAL GORGE PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073332557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL GORGE PSYCHIATRY

Provider Business Mailing Address
First Line	:	1501 MAIN STREET
Second Line	:	PO BOX 102
City	:	CANON CITY
State	:	CO
Zip	:	81212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 SAVAGE LOOP
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-4185
Country	:	US
Telephone Number	:	720-467-9478
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MR. KARL JAMES WEBER
Credential	:	NP
Telephone Number	:	719-420-0238

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	04/07/2025

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Directions to “ROYAL GORGE PSYCHIATRY ” Practice Location

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