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NPI Code Detail

MEDICARE: STATE OF COLORADO

MEDICARE: STATE OF COLORADO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0358CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093702722
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF COLORADO
Provider Business Mailing Address
First Line : 851 EAST 5TH STREET
Second Line :
City : RIFLE
State : CO
Zip : 81650-2941
Country : US
Telephone Number : 970-625-0842
Fax Number : 970-625-3706
Provider Business Practice Location Address
First Line : 851 EAST 5TH STREET
Second Line :
City : RIFLE
State : CO
Zip : 81650-2941
Country : US
Telephone Number : 970-625-0842
Fax Number : 970-625-3706
Authorized Official
Title or Position : MEDICAL RECORDS TECHNICIAN
Name : NIKKI M MAYNARD
Credential : RHIT
Telephone Number : 970-625-0842
Provider Enumeration Date : 09/27/2005
Last Update Date : 02/19/2010

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1366023756 — CAROLYN SYLVIA KERANEN
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Directions to “STATE OF COLORADO ” Practice Location

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