Provider Demographics
NPI:1063599256
Name:SAGUARO FAMILY CLINIC
Entity type:Organization
Organization Name:SAGUARO FAMILY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LADEAN
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN-CNP
Authorized Official - Phone:303-688-8108
Mailing Address - Street 1:1189 S PERRY ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1958
Mailing Address - Country:US
Mailing Address - Phone:303-688-8108
Mailing Address - Fax:303-688-9122
Practice Address - Street 1:1189 S PERRY ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1958
Practice Address - Country:US
Practice Address - Phone:303-688-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808401Medicare PIN