Provider Demographics
NPI:1952729204
Name:ROCK CREEK NEUROSURGERY, LLC
Entity Type:Organization
Organization Name:ROCK CREEK NEUROSURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-609-9310
Mailing Address - Street 1:15 S 1000 E
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5590
Mailing Address - Country:US
Mailing Address - Phone:801-609-9310
Mailing Address - Fax:
Practice Address - Street 1:15 S 1000 E
Practice Address - Street 2:SUITE 225
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5590
Practice Address - Country:US
Practice Address - Phone:801-609-9310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8823947-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty