MEDICARE: COLORADO NEUROSCIENCE CENTER OF THE ROCKIES, 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	2084N0400X	Neurology Physician	41631	CO

General Provider Information

NPI Number	:	1902003676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO NEUROSCIENCE CENTER OF THE ROCKIES, PLLC

Provider Business Mailing Address
First Line	:	1635 FOXTRAIL DR
Second Line	:	SUITE 215
City	:	LOVELAND
State	:	CO
Zip	:	80538-9086
Country	:	US
Telephone Number	:	970-297-8120
Fax Number	:	970-776-3294

Provider Business Practice Location Address
First Line	:	1635 FOXTRAIL DR
Second Line	:	SUITE 215
City	:	LOVELAND
State	:	CO
Zip	:	80538-9086
Country	:	US
Telephone Number	:	970-297-8120
Fax Number	:	970-776-3294

Authorized Official
Title or Position	:	CEO
Name	:	DR. TERRY MARK HIMES
Credential	:	D.O.
Telephone Number	:	970-297-8120

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	05/15/2015

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