Provider Demographics
NPI:1609814284
Name:ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE PC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZWERDLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-486-0500
Mailing Address - Street 1:735 US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3978
Mailing Address - Country:US
Mailing Address - Phone:719-486-0500
Mailing Address - Fax:719-486-3966
Practice Address - Street 1:735 US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3978
Practice Address - Country:US
Practice Address - Phone:719-486-0500
Practice Address - Fax:719-486-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD5084OtherMEDICARE RAILROAD
CO55808255Medicaid
CO55808255Medicaid