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General NPI Number Information
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NPI Number | 1881020899
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Entity Type | Organization
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Legal Business Name | SURGCENTER OF CASTLE ROCK LLC
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 4700 CASTLETON WAY
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City | CASTLE ROCK
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State | CO
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Zip | 80109-7896
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Country | US
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Telephone | 720-519-1418
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Fax | 720-519-1746
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Provider Business Mailing Address
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Address Line | 4700 CASTLETON WAY
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City | CASTLE ROCK
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State | CO
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Zip | 80109-7896
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Country | US
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Telephone | 720-519-1418
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Fax | 720-519-1746
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGG MARTYAK
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Credential | MD
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Telephone | 719-260-4767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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