Provider Demographics
NPI:1124223292
Name:JEANNIE M. OROURKE, DPM PC
Entity Type:Organization
Organization Name:JEANNIE M. OROURKE, DPM PC
Other - Org Name:CASTLE ROCK FOOT AND ANKLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:LYTIKAINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-814-1082
Mailing Address - Street 1:755 S PERRY ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1901
Mailing Address - Country:US
Mailing Address - Phone:303-814-1082
Mailing Address - Fax:303-814-0020
Practice Address - Street 1:755 S PERRY ST
Practice Address - Street 2:SUITE 500
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1901
Practice Address - Country:US
Practice Address - Phone:303-814-1082
Practice Address - Fax:303-814-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 481213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4751540001Medicare NSC
COC476768Medicare PIN