Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Multi-Specialty |
261QM1300X | 70 | Clinic or Group Practice | |
Clinical |
103TC0700X | 62 | Psychologist, Clinical | |
Professional |
101YP2500X | |||
Social Worker |
104100000X |
| NPI Number | 1215553227 |
| LBN Legal business name | COLORADO MOUNTAIN MEDICAL, LLC |
| Authorized official | DIANE VOYTKO - (PHYSICIAN PRESIDENT) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 06/25/2020 |
| Last updated | 06/08/2022 - About 4 years ago |
| Identifiers | n/a |
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