Provider Demographics
NPI:1861961021
Name:CASTLE ROCK MEDICAL WEIGHT LOSS CENTER LLC
Entity type:Organization
Organization Name:CASTLE ROCK MEDICAL WEIGHT LOSS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-924-2548
Mailing Address - Street 1:1 OAKWOOD PARK PLZ STE 206
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1849
Mailing Address - Country:US
Mailing Address - Phone:720-924-2548
Mailing Address - Fax:303-814-1390
Practice Address - Street 1:1 OAKWOOD PARK PLZ STE 206
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1849
Practice Address - Country:US
Practice Address - Phone:720-924-2548
Practice Address - Fax:303-814-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty