Healthcare Provider Details

I. General information

NPI: 1801853551
Provider Name (Legal Business Name): HAXTUN HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W FLETCHER ST
HAXTUN CO
80731-2737
US

IV. Provider business mailing address

235 W FLETCHER ST
HAXTUN CO
80731-2737
US

V. Phone/Fax

Practice location:
  • Phone: 970-774-6123
  • Fax: 970-774-6158
Mailing address:
  • Phone: 970-774-6123
  • Fax: 970-774-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number010112
License Number StateCO

VIII. Authorized Official

Name: MR. LARRY SCHRAGE
Title or Position: CEO
Credential:
Phone: 970-774-6123