Organization · NPI-2

Intermountain Medical Group Denver, LLC

Family Medicine · Cody, WY

NPI number1194696492
StatusActive
Last updated in NPPESSep 17, 2025

Details

NPI
1194696492
Entity type
Organization (NPI-2)
Legal business name
Intermountain Medical Group Denver, LLC
Organization subpart
Yes
Enumeration date
Sep 17, 2025
Certification date
Sep 17, 2025
Last updated
Sep 17, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

424 Yellowstone Ave Ste 130
Cody, WY 82414-9309

Phone 801-442-5502

Mailing address

500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564

Phone 303-272-0566 · Fax 303-272-0390

Authorized official

Jon Mcdaniel
Vp Finance
3032720231

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