Provider Demographics
NPI:1174776009
Name:ROCKY MOUNTAIN DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:HACKNEY
Authorized Official - Last Name:SCATENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-444-0833
Mailing Address - Street 1:2400 SPRUCE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4617
Mailing Address - Country:US
Mailing Address - Phone:303-444-0833
Mailing Address - Fax:303-444-0803
Practice Address - Street 1:2400 SPRUCE ST
Practice Address - Street 2:STE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4617
Practice Address - Country:US
Practice Address - Phone:303-444-0833
Practice Address - Fax:303-444-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41453261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty