Healthcare Provider Details

I. General information

NPI: 1831686674
Provider Name (Legal Business Name): CASTLE ROCK SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 CASTLETON WAY STE 101
CASTLE ROCK CO
80109
US

IV. Provider business mailing address

4700 CASTLETON WAY STE 101
CASTLE ROCK CO
80109-7896
US

V. Phone/Fax

Practice location:
  • Phone: 512-653-4730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCIE CAMPAGNOLA
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 720-519-1418