MEDICARE: SOUTHERN COLORADO UTE SERVICE UNIT

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	332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2003393	OTHER	PK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972670461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COLORADO UTE SERVICE UNIT

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

Provider Business Practice Location Address
First Line	:	232 RUSTLING WILLOW
Second Line	:
City	:	TOWAOC
State	:	CO
Zip	:	81334
Country	:	US
Telephone Number	:	970-565-4441
Fax Number	:	970-565-9163

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/10/2025

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Directions to “SOUTHERN COLORADO UTE SERVICE UNIT ” Practice Location

Language	Start Address	Practice Location

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