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NPI Code Detail

MEDICARE: ROCKY MOUNTAIN VEIN INSTITUTE, PLLC

MEDICARE: ROCKY MOUNTAIN VEIN INSTITUTE, 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
12085R0204XVascular & Interventional Radiology Physician

General Provider Information

NPI Number : 1811613912
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCKY MOUNTAIN VEIN INSTITUTE, PLLC
Provider Business Mailing Address
First Line : PO BOX 7702
Second Line :
City : LOVELAND
State : CO
Zip : 80537-0702
Country : US
Telephone Number : 970-663-2742
Fax Number : 970-667-0847
Provider Business Practice Location Address
First Line : 255 S ROUTT ST STE 265
Second Line :
City : LAKEWOOD
State : CO
Zip : 80228-2214
Country : US
Telephone Number : 719-299-3967
Fax Number :
Authorized Official
Title or Position : AUTHORIZED REPRESENTATIVE
Name : GORDON F GIBBS
Credential : MD
Telephone Number : 719-543-8346
Provider Enumeration Date : 10/19/2022
Last Update Date : 10/19/2022

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