| Rocky Mountain Family Practice | |
|
205 S Main St Ste B Longmont CO 80501-1714 | |
| (303) 772-6244 | |
| (303) 702-1623 |
| Full Name | Rocky Mountain Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 205 S Main St Ste B, Longmont, Colorado |
| Authorized Official Name and Position | James M Fretwell (OWNER/PRESIDENT) |
| Authorized Official Contact | 3037726244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rocky Mountain Family Practice 205 S Main St Suite B Longmont CO 80501-1716 Ph: (303) 772-6244 | Rocky Mountain Family Practice 205 S Main St Ste B Longmont CO 80501-1714 Ph: (303) 772-6244 |
| NPI Number | 1184633364 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 04/27/2022 |
| Medicare PECOS PAC ID | 5890761613 |
|---|---|
| Medicare Enrollment ID | O20040902001297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184633364 | NPI | - | NPPES |
| 83350870 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Colorado) | Primary |
| Provider Name | Ammie E Christiansen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912976259 PECOS PAC ID: 9335148972 Enrollment ID: I20061208000565 |
| Provider Name | Diane P Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033252044 PECOS PAC ID: 2264538214 Enrollment ID: I20070508000243 |
| Provider Name | Paul L Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285654608 PECOS PAC ID: 8921139205 Enrollment ID: I20100630000531 |
| Provider Name | James M Fretwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053331603 PECOS PAC ID: 5597764977 Enrollment ID: I20100811001037 |
| Provider Name | Brian Robert Hughes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346262995 PECOS PAC ID: 7315063880 Enrollment ID: I20100922000581 |
| Provider Name | Eric D Mast |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427346287 PECOS PAC ID: 3971736091 Enrollment ID: I20160923000862 |
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