Provider Demographics
NPI:1548289614
Name:CASTLE ROCK PEDIATRICS PLLC
Entity type:Organization
Organization Name:CASTLE ROCK PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:THIEME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-688-2228
Mailing Address - Street 1:1001 S PERRY ST
Mailing Address - Street 2:STE 101B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2668
Mailing Address - Country:US
Mailing Address - Phone:303-688-2228
Mailing Address - Fax:303-663-0640
Practice Address - Street 1:1001 S PERRY ST
Practice Address - Street 2:STE 101B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2668
Practice Address - Country:US
Practice Address - Phone:303-688-2228
Practice Address - Fax:303-663-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31685261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care