Provider Demographics
NPI:1003520701
Name:ROCK SPRINGS PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:ROCK SPRINGS PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:502-381-3338
Mailing Address - Street 1:4801 OLYMPIA PARK PLZ STE 1000
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2090
Mailing Address - Country:US
Mailing Address - Phone:412-588-3546
Mailing Address - Fax:
Practice Address - Street 1:5610 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5519
Practice Address - Country:US
Practice Address - Phone:512-942-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK SPRINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty