Intermountain Medical Group Denver, LLC

Organization Active NPI Family Medicine Physician · Wheat Ridge, CO

NPI 1154967719 · NPPES record last updated Jun 28, 2024

Key facts

NPI
1154967719
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Practice address
8550 W 38TH Ave Ste 220
Wheat Ridge, CO 80033-4300
Phone
(303) 403-3670
Fax
(303) 423-9293
NPI assigned
Nov 19, 2019
Organization subpart
Yes
Parent organization (as reported)
INTERMOUNTAIN FRONT RANGE, INC.

Authorized official

Name
Jon McDaniel
Title
VP Finance Medical Group
Phone
(303) 272-0231

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 42

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20150106000131 CO Part B Supplier - Clinic/Group Practice 0840513552 Receives reassigned benefits from 1,361 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Intermountain Medical Group Denver LLC (121 organizations share this tax ID)
Part of
Lutheran Medical Center

Locations

12169 Sheridan Blvd
Broomfield, CO 80020
Phone (303) 439-0169

8550 W 38th Ave
Ste 220
Wheat Ridge, CO 80033
Phone (303) 403-3670

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
207Q00000X Yes

Addresses

Primary practice location

8550 W 38TH Ave Ste 220
Wheat Ridge, CO 80033-4300

Mailing address

8550 W 38TH Ave Ste 220
Wheat Ridge, CO 80033-4300
Phone (303) 403-3670

Other names

  • SCL Health Medical Group - Lutheran Family Practice Doing business as

Other providers in Wheat Ridge, CO

All providers in Wheat Ridge, CO · Family Medicine Physician in Colorado

Sources for this page

Verify at the official NPI Registry.