Healthcare Provider Details

I. General information

NPI: 1952717878
Provider Name (Legal Business Name): HAXTUN HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S COLORADO AVE
HAXTUN CO
80731-5011
US

IV. Provider business mailing address

235 W FLETCHER ST
HAXTUN CO
80731-2737
US

V. Phone/Fax

Practice location:
  • Phone: 970-774-6979
  • Fax: 970-774-7598
Mailing address:
  • Phone: 970-774-6979
  • Fax: 970-774-7598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1680000065
License Number StateCO

VIII. Authorized Official

Name: DR. ELLEN A MCCONNELL
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 970-774-6979