Provider Demographics
NPI:1194116277
Name:ROCKY MOUNTAIN NEUROSURGERY, P.C.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN NEUROSURGERY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-222-9745
Mailing Address - Street 1:9695 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2888
Mailing Address - Country:US
Mailing Address - Phone:720-484-6908
Mailing Address - Fax:720-484-6918
Practice Address - Street 1:9695 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2888
Practice Address - Country:US
Practice Address - Phone:720-484-6908
Practice Address - Fax:720-484-6918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN NEUROSURGERY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC525688OtherMEDICARE
CO42315OtherMEDICAL LICENSE
CO89582578Medicaid
COI01796Medicare UPIN