1497884845 NPI number — MONTEZUMA-CORTEZ SCHOOL DISTRICT RE-1

Table of content: (NPI 1497884845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497884845 NPI number — MONTEZUMA-CORTEZ SCHOOL DISTRICT RE-1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTEZUMA-CORTEZ SCHOOL DISTRICT RE-1
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:
CORTEZ SCHOOL DISTRICT
Provider Other Organization Name Type Code:
5
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:
1497884845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTEZ
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81321-0708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-565-7282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTEZ
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81321-2736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-565-7522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
MARLEE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAID COORDINATOR
Authorized Official Telephone Number:
719-588-0397

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 45974764 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".