Intermountain Medical Group Denver, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

Practice address

424 Yellowstone Ave Ste 130
Cody, WY 82414-9309

Phone

(801) 442-5502

NPI assigned

Sep 17, 2025

Last updated

Sep 17, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jon McDaniel

Title

VP Finance

Phone

(303) 272-0231

Specialties & licenses 1

Addresses

Tax ID family

SCL Health Medical Group121 organizations share this tax ID, including this one

Part of

Exempla Healthcare

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1194696492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 4300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213564",
            "telephone_number": "303-272-0566",
            "fax_number": "303-272-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 YELLOWSTONE AVE STE 130",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824149309",
            "telephone_number": "801-442-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2025-09-17",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Cody, WY
• Providers in Cody, WY by specialty
• Family Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.