Provider Demographics
NPI:1962948877
Name:SOUTH METRO INTEGRATED CLINIC
Entity type:Organization
Organization Name:SOUTH METRO INTEGRATED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRET
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-842-0367
Mailing Address - Street 1:1823 FORD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2545
Mailing Address - Country:US
Mailing Address - Phone:303-842-0367
Mailing Address - Fax:888-382-8131
Practice Address - Street 1:9299 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5603
Practice Address - Country:US
Practice Address - Phone:619-693-4227
Practice Address - Fax:888-382-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty