1386795656 NPI number — CASTLE ROCK FAMILY PHYSICIANS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386795656 NPI number — CASTLE ROCK FAMILY PHYSICIANS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTLE ROCK FAMILY PHYSICIANS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386795656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
755 S PERRY ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CASTLE ROCK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80104-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-688-8989
Provider Business Mailing Address Fax Number:
303-688-3482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 S PERRY ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80104-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-688-8989
Provider Business Practice Location Address Fax Number:
303-688-3482
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KASUNIC
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
BAIRD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-688-8989

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  28038 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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