Provider Demographics
NPI:1699095190
Name:MOUNTAINOCCUPATIONALMEDICINE LLC
Entity type:Organization
Organization Name:MOUNTAINOCCUPATIONALMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:GELLRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-877-6113
Mailing Address - Street 1:2838 OLYMPIA CIR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8800
Mailing Address - Country:US
Mailing Address - Phone:303-877-6113
Mailing Address - Fax:303-986-3680
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE #311
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:303-877-6113
Practice Address - Fax:303-425-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21414261QR0405X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder