Provider Demographics
NPI:1235879925
Name:RED ROCK MILITARY SERVICES
Entity Type:Organization
Organization Name:RED ROCK MILITARY SERVICES
Other - Org Name:THE STEVEN A COHEN MILITARY FAMILY CLINIC AT RED ROCK
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL-DUVERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-425-0428
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5104
Mailing Address - Country:US
Mailing Address - Phone:405-424-7711
Mailing Address - Fax:
Practice Address - Street 1:1915 AEROTECH DR STE 112
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4219
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health