Provider Demographics
NPI:1194093906
Name:ROCKY MOUNTAIN REGIONAL HEALTH SERVICE
Entity type:Organization
Organization Name:ROCKY MOUNTAIN REGIONAL HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-668-1791
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:C/O ROCKY MOUNTAIN MSO, LLC
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1292
Mailing Address - Country:US
Mailing Address - Phone:970-668-1791
Mailing Address - Fax:970-668-1792
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-1791
Practice Address - Fax:970-668-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care