Provider Demographics
NPI:1841621406
Name:CREEKSIDE SPECIALTY PHYSICIANS LLC
Entity type:Organization
Organization Name:CREEKSIDE SPECIALTY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:OROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-902-5657
Mailing Address - Street 1:120 OLD LARAMIE TRL E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-7012
Mailing Address - Country:US
Mailing Address - Phone:303-926-9800
Mailing Address - Fax:
Practice Address - Street 1:120 OLD LARAMIE TRL E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7012
Practice Address - Country:US
Practice Address - Phone:303-926-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty