# FOUNDERS - CENTURA MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Founders - Centura Medical Group LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396207767
- **Authorized official:** ANGELA SKINNER (DIRECTOR OFFICE OF MEDICAL AFFAIRS)
- **Authorized official phone:** (303) 673-7175

## Contact information

- **Practice address:** 4386 TRAIL BOSS DR STE A, CASTLE ROCK, CO 80104-7512
- **Practice address phone:** (303) 688-8666
- **Practice address fax:** (303) 687-8260
- **Mailing address:** PO BOX 848349, BOSTON, MA 02284-8349
- **Mailing address phone:** (303) 688-8666
- **Mailing address fax:** (303) 688-8260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 04/03/2019
- **Last updated:** 04/03/2019