Provider Demographics
NPI:1144524760
Name:INNER MOUNTAIN PSYCHIATRY, INC.
Entity type:Organization
Organization Name:INNER MOUNTAIN PSYCHIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ELSASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-485-5369
Mailing Address - Street 1:PO BOX 8498
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8498
Mailing Address - Country:US
Mailing Address - Phone:970-485-5369
Mailing Address - Fax:
Practice Address - Street 1:1905 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8498
Practice Address - Country:US
Practice Address - Phone:970-485-5369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO456462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty