Provider Demographics
NPI:1104959956
Name:ROCKY MOUNTAIN PLASTIC SURGERY P.C.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-945-1144
Mailing Address - Street 1:1830 BLAKE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4261
Mailing Address - Country:US
Mailing Address - Phone:970-945-1144
Mailing Address - Fax:970-945-9138
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4261
Practice Address - Country:US
Practice Address - Phone:970-945-1144
Practice Address - Fax:970-945-9138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15728382Medicaid
COA79025Medicare UPIN
COC421308Medicare PIN