MEDICARE: VERNON M RUBICK, D.O. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	207Q00000X	Family Medicine Physician	37183	CO

General Provider Information

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

Provider Business Mailing Address
First Line	:	8540 SCARBOROUGH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7502
Country	:	US
Telephone Number	:	719-955-4200
Fax Number	:	719-955-4201

Provider Business Practice Location Address
First Line	:	8540 SCARBOROUGH DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7502
Country	:	US
Telephone Number	:	719-955-4200
Fax Number	:	719-955-4201

Authorized Official
Title or Position	:	OWNER
Name	:	VERNON M RUBICK
Credential	:	D.O.
Telephone Number	:	719-955-4200

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/04/2011

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