Basic Information
| Provider Information | |||||||||
| NPI: | 1396706693 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCKY MOUNTAIN URGENT CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AURORA HEALTH CARE SERVICES PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 174457 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802174457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039453299 | ||||||||
| FaxNumber: | 3039453303 | ||||||||
| Practice Location | |||||||||
| Address1: | 13650 EAST MISSISSIPPI AVE, SUITE 100B | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036951338 | ||||||||
| FaxNumber: | 3036958814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GLUCHACKI | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SVP. COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 5086899706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 138243 | CO | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QU0200X | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 71885544 | 05 | CO | MEDICAID |