Provider Demographics
NPI:1881020899
Name:SURGCENTER OF CASTLE ROCK LLC
Entity Type:Organization
Organization Name:SURGCENTER OF CASTLE ROCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-260-4767
Mailing Address - Street 1:4700 CASTLETON WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-7896
Mailing Address - Country:US
Mailing Address - Phone:720-519-1418
Mailing Address - Fax:720-519-1746
Practice Address - Street 1:4700 CASTLETON WAY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-7896
Practice Address - Country:US
Practice Address - Phone:720-519-1418
Practice Address - Fax:720-519-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical