=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063599256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGUARO FAMILY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 09/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1189 S PERRY ST SUITE 220
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80104-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-688-8108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1189 S PERRY ST SUITE 220
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80104-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-688-8108
-----------------------------------------------------
Fax | 303-688-9122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. GAIL LADEAN CROSS
-----------------------------------------------------
Credential | RN-CNP
-----------------------------------------------------
Telephone | 303-688-8108
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 57204
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------