Healthcare Provider Details

I. General information

NPI: 1982898425
Provider Name (Legal Business Name): VERNON M RUBICK, D.O. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR
COLORADO SPRINGS CO
80920-7502
US

IV. Provider business mailing address

8540 SCARBOROUGH DR
COLORADO SPRINGS CO
80920-7502
US

V. Phone/Fax

Practice location:
  • Phone: 719-955-4200
  • Fax: 719-955-4201
Mailing address:
  • Phone: 719-955-4200
  • Fax: 719-955-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37183
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VERNON M RUBICK
Title or Position: OWNER
Credential: D.O.
Phone: 719-955-4200