Organization Name: | ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE PC |
NPI Number: | 1659647592 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA ZWERDLINGER (PRESIDENT) |
Mailing Address: | 735 Us Highway 24 Leadville |
State: | CO US |
Postal Code: | 804613978 |
Phone Number: | 7194860500 |
Fax Number: | 7194863966 |
NPI Enumeration Date: | 03/26/2012 |
NPI Last Update Date: | 03/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | 063875 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |