Provider Demographics
NPI:1346065182
Name:COLORADO MOUNTAIN COLLEGE
Entity type:Organization
Organization Name:COLORADO MOUNTAIN COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL & ADMINISTRATIVE COORDINAT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-569-2950
Mailing Address - Street 1:150 MILLER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-6420
Mailing Address - Country:US
Mailing Address - Phone:970-569-2950
Mailing Address - Fax:
Practice Address - Street 1:150 MILLER RANCH RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6420
Practice Address - Country:US
Practice Address - Phone:970-569-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental