Organization
ROARING FORK SURGICAL ASSOCIATES PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD NICHOL MD (GENERAL SURGEON)
(970) 945-6533
Entity
Organization
Contact information
Practice address
1906 BLAKE AVE, GLENWOOD SPRINGS, CO 81601-4227
(970) 945-6533
(970) 945-3945
Mailing address
1906 BLAKE AVE, GLENWOOD SPRINGS, CO 81601-4227
(970) 945-6533
(970) 945-3945
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
80.05611.1
CO
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04020459
—
CO
01
—
607484
BCBS
CO
01
—
CG 5876
RR MEDICARE
CO
Enumeration date
01/08/2007
Last updated
02/21/2018
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