1174772073 NPI number — DOLORES COUNTY COMMISSIONERS

Table of content: KIRSTEN LENEE WILLIAMS APC (NPI 1124789813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174772073 NPI number — DOLORES COUNTY COMMISSIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOLORES COUNTY COMMISSIONERS
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:
DOLORES COUNTY PUBLIC HEALTH
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:
1174772073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVE CREEK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-677-2387
Provider Business Mailing Address Fax Number:
970-677-2948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DOVE CREEK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-677-2387
Provider Business Practice Location Address Fax Number:
970-677-2948
Provider Enumeration Date:
09/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RANDOLPH
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
970-677-2387

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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