Provider Demographics
NPI:1215054259
Name:ROCKY MOUNTAIN FAMILY PHYSICIANS
Entity type:Organization
Organization Name:ROCKY MOUNTAIN FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-484-0798
Mailing Address - Street 1:1124 E ELIZABETH ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4052
Mailing Address - Country:US
Mailing Address - Phone:970-484-0798
Mailing Address - Fax:970-482-0679
Practice Address - Street 1:1124 E ELIZABETH ST
Practice Address - Street 2:BLDG C
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4052
Practice Address - Country:US
Practice Address - Phone:970-484-0798
Practice Address - Fax:970-482-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007324Medicaid
CO04007324Medicaid