Healthcare Provider Details

I. General information

NPI: 1417191933
Provider Name (Legal Business Name): TELLER COUNTY PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 W. HWY. 24 UNIT 2C
DIVIDE CO
80814
US

IV. Provider business mailing address

PO BOX 928 UNIT 2C
DIVIDE CO
80814-0928
US

V. Phone/Fax

Practice location:
  • Phone: 719-687-6414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251KOOOOOX
License Number StateCO

VIII. Authorized Official

Name: MRS. CHRISTINA RUBIN
Title or Position: DIRECTOR
Credential: APN
Phone: 719-687-6416