Provider Demographics
NPI:1306353586
Name:SDG CASTLE ROCK ENDOSCOPY CENTER
Entity type:Organization
Organization Name:SDG CASTLE ROCK ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-8888
Mailing Address - Street 1:10 INVERNESS DR E STE 220
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5612
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:303-768-8774
Practice Address - Street 1:3911 AMBROSIA ST # 200
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3820
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:303-788-6452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SDG HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-09
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical