# INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INTERMOUNTAIN FRONT RANGE, INC.
- **Other names:** Firestone Clinic, Firestone Clinic - Neurology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568070944
- **Legal business name:** INTERMOUNTAIN FRONT RANGE, INC.
- **Authorized official:** JON MCDANIEL (VP OF FINANCE)
- **Authorized official phone:** (303) 272-0231

## Contact information

- **Practice address:** 8350 COLORADO BLVD UNIT 160, FIRESTONE, CO 80504-6803
- **Practice address phone:** (303) 689-5160
- **Practice address fax:** (303) 689-5175
- **Mailing address:** 500 ELDORADO BLVD STE 6300, BROOMFIELD, CO 80021-3422
- **Mailing address phone:** (303) 272-0566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2083X0100X | Occupational Medicine Physician | — | NULL | — |
| 2083X0100X | Occupational Medicine Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |

## Other

- **Enumeration date:** 07/21/2020
- **Last updated:** 06/28/2024