Healthcare Provider Details

I. General information

NPI: 1538266762
Provider Name (Legal Business Name): COUNTY OF EL PASO SCHOOL DISTRICT 20
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CHAPEL HILLS DR
COLORADO SPRINGS CO
80920-3923
US

IV. Provider business mailing address

1110 CHAPEL HILLS DR
COLORADO SPRINGS CO
80920-3923
US

V. Phone/Fax

Practice location:
  • Phone: 719-234-1200
  • Fax:
Mailing address:
  • Phone: 719-234-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MISS MARCIA H DE JONG
Title or Position: MEDICAID COORDINATOR
Credential: RN
Phone: 719-930-6928