MEDICARE: TELLER COUNTY

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
1	261QP0905X	State or Local Public Health Clinic/Center	04540548	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1104998822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELLER COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 928
Second Line	:
City	:	DIVIDE
State	:	CO
Zip	:	80814-0928
Country	:	US
Telephone Number	:	719-687-6416
Fax Number	:	719-687-6501

Provider Business Practice Location Address
First Line	:	11115 W. HIGHWAY 24
Second Line	:	UNIT 2C
City	:	DIVIDE
State	:	CO
Zip	:	80814
Country	:	US
Telephone Number	:	719-687-6416
Fax Number	:	719-687-6501

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. CHRISTINA GOETTGE RUBIN
Credential	:	N.P., R.N.
Telephone Number	:	719-687-6416

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/08/2010

Similar Medicare Providers

1982672689 — DR. CYNTHIA S TOWNSEND DNP
Practice Location Address:

63 BEAR CLAW TRL
DIVIDE, CO
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Practice Fax:

1518993757 — GREGORY UNRUH DO
Practice Location Address:

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80814

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1770665671 — BARBARA JEAN WEGENER LPC
Practice Location Address:

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1346310380 — MRS. LORRAINE AGOLD-RICH RN, BSN, CRRN
Practice Location Address:

11505 HWY. 24
DIVIDE, CO
80814-0928

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Practice Fax:

1144390329 — MRS. MIRANDA JO DAVID R.N.
Practice Location Address:

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80814

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Practice Fax:

1548337249 — MRS. JENNIFER L MCCARTHY P.A.-C
Practice Location Address:

34 HYBROOK RD SOUTH
DIVIDE, CO
80814

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Directions to “TELLER COUNTY ” Practice Location

Language	Start Address	Practice Location

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