1972670461 NPI number — SOUTHERN COLORADO UTE SERVICE UNIT

Table of content: (NPI 1972670461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972670461 NPI number — SOUTHERN COLORADO UTE SERVICE UNIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN COLORADO UTE SERVICE UNIT
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:
1972670461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101-0033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-565-4441
Provider Business Mailing Address Fax Number:
970-565-4784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 RUSTLING WILLOW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWAOC
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-565-4441
Provider Business Practice Location Address Fax Number:
970-565-9163
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANSING
Authorized Official First Name:
LUCY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
970-565-4441

Provider Taxonomy Codes

  • Taxonomy code: 332800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67123 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700000000009 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2003393 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 708000 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43205542 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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