| Rocky Mountain Sports Medicine Inc. | |
|
12760 Stroh Ranch Way Ste 202 Parker CO 80134-7507 | |
| (720) 851-5420 | |
| (720) 851-5801 |
| Full Name | Rocky Mountain Sports Medicine Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 12760 Stroh Ranch Way Ste 202, Parker, Colorado |
| Authorized Official Name and Position | Kathryn Vidlock Granley (OWNER/PHYSICIAN) |
| Authorized Official Contact | 7205920112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rocky Mountain Sports Medicine Inc. 12760 Stroh Ranch Way Ste 202 Parker CO 80134-7507 Ph: (720) 592-0112 | Rocky Mountain Sports Medicine Inc. 12760 Stroh Ranch Way Ste 202 Parker CO 80134-7507 Ph: (720) 851-5420 |
| NPI Number | 1588210934 |
|---|---|
| Provider Enumeration Date | 08/12/2019 |
| Last Update Date | 10/16/2019 |
| Medicare PECOS PAC ID | 3870926488 |
|---|---|
| Medicare Enrollment ID | O20191211002258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588210934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Kathryn A Vidlock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184662272 PECOS PAC ID: 5193707537 Enrollment ID: I20130905000533 |
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