1386777266 NPI number — SALUD FAMILY HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386777266 NPI number — SALUD FAMILY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALUD FAMILY HEALTH
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:
SALUD FAMILY HEALTH CENTERS
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:
1386777266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 S ROLLIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LUPTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80621-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-286-4560
Provider Business Mailing Address Fax Number:
303-286-4589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LUPTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80621-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-697-2583
Provider Business Practice Location Address Fax Number:
303-322-9434
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNOR
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
HEALTH
Authorized Official Title or Position:
MANAGER OF DECISION SUPPORT AND REV
Authorized Official Telephone Number:
303-286-4560

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05680004 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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