Healthcare Provider Details

I. General information

NPI: 1245906023
Provider Name (Legal Business Name): STROCK MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5277 MANHATTAN CIR STE 220
BOULDER CO
80303-8231
US

IV. Provider business mailing address

1401 WEWATTA ST UNIT 603
DENVER CO
80202-1346
US

V. Phone/Fax

Practice location:
  • Phone: 303-720-1845
  • Fax: 303-479-4958
Mailing address:
  • Phone: 303-720-1845
  • Fax: 303-479-4958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: AUDREY ALANA STROCK
Title or Position: OWNER
Credential:
Phone: 303-720-1845