MEDICARE: ROCKY MOUNTAIN PLASTIC SURGERY P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	36386	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104959956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN PLASTIC SURGERY P.C.

Provider Business Mailing Address
First Line	:	1830 BLAKE AVE
Second Line	:	SUITE 207
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4261
Country	:	US
Telephone Number	:	970-945-1144
Fax Number	:	970-945-9138

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVE
Second Line	:	SUITE 207
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4261
Country	:	US
Telephone Number	:	970-945-1144
Fax Number	:	970-945-9138

Authorized Official
Title or Position	:	MANAGER
Name	:	KATIE DEHM
Credential	:
Telephone Number	:	970-945-1144

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/17/2008

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Directions to “ROCKY MOUNTAIN PLASTIC SURGERY P.C. ” Practice Location

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