Basic Information
| Provider Information | |||||||||
| NPI: | 1538253422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN SURGICAL ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4545 E 9TH AVE | ||||||||
| Address2: | STE 460 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033882922 | ||||||||
| FaxNumber: | 3033882962 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 E 9TH AVE | ||||||||
| Address2: | STE 460 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033882922 | ||||||||
| FaxNumber: | 3033882962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | PLAUS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3033882922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04695045 | 05 | CO | MEDICAID |