Healthcare Provider Details

I. General information

NPI: 1992550966
Provider Name (Legal Business Name): COUNTY OF LA PLATA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 03/24/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MERCURY VILLAGE DR STE 115
DURANGO CO
81301-8955
US

IV. Provider business mailing address

C/O CLINICAL SERVICES - 150 MERCURY VILLAGE DRIVE SUITE 115
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-828-8850
  • Fax: 970-247-9126
Mailing address:
  • Phone: 970-828-8850
  • Fax: 970-247-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: THERESA ANSELMO
Title or Position: PUBLIC HEALTH DIRECTOR
Credential:
Phone: 970-382-6180