MEDICARE: ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC

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	207RG0100X	Gastroenterology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN3117	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1669414272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	3333 S WADSWORTH BLVD
Second Line	:	STE. D-100
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5122
Country	:	US
Telephone Number	:	303-205-1090
Fax Number	:	303-205-1120

Provider Business Practice Location Address
First Line	:	3333 S WADSWORTH BLVD
Second Line	:	STE. D-100
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-5122
Country	:	US
Telephone Number	:	303-205-1090
Fax Number	:	303-205-1120

Authorized Official
Title or Position	:	CFO
Name	:	ALEXANDER P. CMIL
Credential	:
Telephone Number	:	303-205-1090

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	11/04/2016

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