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NPI Code Detail

MEDICARE: ROCKY MOUNTAIN BRAIN INJURY SERVICES, LLC

MEDICARE: ROCKY MOUNTAIN BRAIN INJURY SERVICES, LLC
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1194031575
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCKY MOUNTAIN BRAIN INJURY SERVICES, LLC
Provider Business Mailing Address
First Line : 2812 E BIJOU ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-6339
Country : US
Telephone Number : 719-457-0660
Fax Number : 719-314-0149
Provider Business Practice Location Address
First Line : 1420 E FOUNTAIN BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80910-3502
Country : US
Telephone Number : 719-457-0660
Fax Number : 719-314-0149
Authorized Official
Title or Position : ACOUNTANT
Name : TRACY MADIGAN
Credential :
Telephone Number : 719-623-1148
Provider Enumeration Date : 08/24/2010
Last Update Date : 08/24/2010

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