Healthcare Provider Details

I. General information

NPI: 1578647152
Provider Name (Legal Business Name): RED ROCKS PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 ALLISON WAY STE 100
ARVADA CO
80005-4428
US

IV. Provider business mailing address

7975 ALLISON WAY STE 100
ARVADA CO
80005-4428
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-7677
  • Fax: 303-422-6029
Mailing address:
  • Phone: 303-422-7677
  • Fax: 303-422-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JODY S KARRASCH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 303-422-7677