1609834449 NPI number — COUNTY OF CHAFFEE

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 1609834449 NPI number — COUNTY OF CHAFFEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CHAFFEE
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:
Provider Other Organization Name Type Code:
6
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:
1609834449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
448 E 1ST ST
Provider Second Line Business Mailing Address:
SUITE 137
Provider Business Mailing Address City Name:
SALIDA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81201-2804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-539-4510
Provider Business Mailing Address Fax Number:
719-539-7197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
448 E 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 137
Provider Business Practice Location Address City Name:
SALIDA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81201-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-539-4510
Provider Business Practice Location Address Fax Number:
719-539-7197
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSTROM
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
719-539-4510

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 600001932 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04419099 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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