1477638971 NPI number — PHC-FORT MORGAN INC

Table of content: (NPI 1477638971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477638971 NPI number — PHC-FORT MORGAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHC-FORT MORGAN INC
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:
COLORADO PLAINS MEDICAL CENTER
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:
1477638971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 SEVEN SPRINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7000
Provider Business Mailing Address Fax Number:
615-920-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MORGAN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80701-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-867-3391
Provider Business Practice Location Address Fax Number:
970-542-3306
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DILLON
Authorized Official First Name:
TERRANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
502-596-7220

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  0112 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025378000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1765503 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347907 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64953238 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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