Healthcare Provider Details

I. General information

NPI: 1184155756
Provider Name (Legal Business Name): CASTLE PINES URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE I
CASTLE PINES CO
80108-9452
US

IV. Provider business mailing address

7280 LAGAE RD STE I
CASTLE PINES CO
80108-9452
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax: 303-814-6491
Mailing address:
  • Phone: 303-814-0505
  • Fax: 303-814-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number0032016
License Number StateCO

VIII. Authorized Official

Name: LAWRENCE S. WILNER
Title or Position: MD/OWNER
Credential: MD
Phone: 303-814-0505