Provider Demographics
NPI:1215981634
Name:ROCKY MOUNTAIN PRIMARY CARE , PC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN PRIMARY CARE , PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-282-9568
Mailing Address - Street 1:7625 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4567
Mailing Address - Country:US
Mailing Address - Phone:303-252-7790
Mailing Address - Fax:303-650-2287
Practice Address - Street 1:7625 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4567
Practice Address - Country:US
Practice Address - Phone:303-252-7790
Practice Address - Fax:303-650-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORO103008OtherGROUP ANTHEM BCBS
CO1215981634OtherGROUP NPI #
CO04020541Medicaid
CORO103008OtherGROUP ANTHEM BCBS