Basic Information
| Provider Information | |||||||||
| NPI: | 1205221397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCK SPRINGS PHYSICIAN GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 5TH ST | ||||||||
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| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125883546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 SE INNER LOOP | ||||||||
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| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786267700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128199400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2015 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVO / CFO | ||||||||
| AuthorizedOfficialTelephone: | 4125883546 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.