Basic Information
| Provider Information | |||||||||
| NPI: | 1699055483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RMBMD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72 EAGLE RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | GRANBY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804468808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077569445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4401 UNION ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805342800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077569445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | BIERDEN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2077569445 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 80974333 | 05 | CO | MEDICAID |