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Organization
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Active
Organization
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Active
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.
Other names
Green Mountain Clinic - Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERMOUNTAIN FRONT RANGE, INC.
Authorized official
JON MCDANIEL (VP OF FINANCE)
(303) 272-0231
Entity
Organization
Contact information
Practice address
12790 W ALAMEDA PKWY STE A, LAKEWOOD, CO 80228-2850
(303) 403-6350
(303) 403-6372
Mailing address
500 ELDORADO BLVD STE 6300, BROOMFIELD, CO 80021-3422
(303) 272-0566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2083X0100X
Occupational Medicine Physician
—
NULL
2083X0100X
Occupational Medicine Physician
—
—
Other
Enumeration date
07/21/2020
Last updated
06/28/2024
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