Provider Demographics
NPI:1285747238
Name:CASTLE ROCK MEDICAL CLINIC, P.C.
Entity type:Organization
Organization Name:CASTLE ROCK MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-688-0662
Mailing Address - Street 1:3 OAKWOOD PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1887
Mailing Address - Country:US
Mailing Address - Phone:303-688-0660
Mailing Address - Fax:303-660-8029
Practice Address - Street 1:3 OAKWOOD PARK PLZ
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1887
Practice Address - Country:US
Practice Address - Phone:303-688-0660
Practice Address - Fax:303-660-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO355508Medicare ID - Type Unspecified