Basic Information
| Provider Information | |||||||||
| NPI: | 1942605381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL CENTER OF THE ROCKIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 E HARMONY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805288620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702377000 | ||||||||
| FaxNumber: | 9702377090 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706241200 | ||||||||
| FaxNumber: | 9706241290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 10/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | DOUGHTY | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9702377000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDICAL CENTER OF THE ROCKIES | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 01D460 | CO | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 76821820 | 05 | CO | MEDICAID | C807761 | 01 | CO | MEDICARE PART B | OTHER | DG4635 | 01 | CO | RAILROAD MEDICARE | OTHER |