Provider Demographics
NPI:1366606709
Name:ROCKY VISTA HEALTH CENTER LLC
Entity type:Organization
Organization Name:ROCKY VISTA HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-875-2880
Mailing Address - Street 1:8401 S CHAMBERS RD STE H-101
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9498
Mailing Address - Country:US
Mailing Address - Phone:303-373-2008
Mailing Address - Fax:
Practice Address - Street 1:8401 S CHAMBERS RD STE H-101
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9498
Practice Address - Country:US
Practice Address - Phone:720-875-2880
Practice Address - Fax:720-875-2877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY VISTA UNIVERSITY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-15
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health