MEDICARE: NEUROLOGY OF THE ROCKIES, 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
1	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DR.0043539	OTHER	CO	CO MEDICAL LICENSE

General Provider Information

NPI Number	:	1548979123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY OF THE ROCKIES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 630920
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80163-0920
Country	:	US
Telephone Number	:	303-840-5051
Fax Number	:	303-840-5058

Provider Business Practice Location Address
First Line	:	950 E HARVARD AVE STE 570
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-7003
Country	:	US
Telephone Number	:	303-840-5051
Fax Number	:	303-840-5058

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	RAVI C SHAH
Credential	:	MD
Telephone Number	:	303-840-5051

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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