Healthcare Provider Details

I. General information

NPI: 1770547440
Provider Name (Legal Business Name): COUNTY OF ALAMOSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 INDEPENDENCE WAY
ALAMOSA CO
81101-9412
US

IV. Provider business mailing address

8900 INDEPENDENCE WAY BUILDING B
ALAMOSA CO
81101-9412
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-6639
  • Fax: 719-589-1103
Mailing address:
  • Phone: 719-589-6639
  • Fax: 719-589-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberC30006
License Number StateCO

VIII. Authorized Official

Name: MR. GEORGE B SHIOSHITA
Title or Position: ADMINISTRATOR
Credential:
Phone: 719-589-6639