Provider Demographics
NPI:1588330609
Name:STROCK MEDICAL GROUP LLC
Entity type:Organization
Organization Name:STROCK MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:ALANA
Authorized Official - Last Name:STROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-720-1845
Mailing Address - Street 1:1401 WEWATTA ST UNIT 360
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1332
Mailing Address - Country:US
Mailing Address - Phone:303-720-1845
Mailing Address - Fax:
Practice Address - Street 1:1391 SPEER BLVD STE 360
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2632
Practice Address - Country:US
Practice Address - Phone:303-720-1845
Practice Address - Fax:303-479-4958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STROCK MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty