1174515258 NPI number — COUNTY OF WELD

Table of content: (NPI 1174515258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174515258 NPI number — COUNTY OF WELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF WELD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174515258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 N 17TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREELEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80631-9117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-304-6410
Provider Business Mailing Address Fax Number:
970-304-6412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 N 17TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80631-9117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-304-6410
Provider Business Practice Location Address Fax Number:
970-304-6412
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HORN
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIEF NURSING OFFICER
Authorized Official Telephone Number:
970-304-6420

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP0905X , with the licence number: OO.0000241 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000119877 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMIS643628 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com