Organization
HEART CENTER OF THE ROCKIES CATH LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE RICHARDSON (ADMINISTRATOR)
(970) 297-6931
Entity
Organization
Contact information
Practice address
2500 ROCKY MOUNTAIN AVE, LOVELAND, CO 80538
(970) 624-1756
(970) 624-1792
Mailing address
2121 E HARMONY RD, STE 100, FORT COLLINS, CO 80528-3400
(970) 297-6866
(970) 297-6862
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
31863
CO
207RI0011X
Interventional Cardiology Physician
Primary
31863
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25139347
—
CO
01
—
HE642103
ANTHEM BCBS
CO
Enumeration date
08/11/2005
Last updated
02/22/2008
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