Healthcare Provider Details

I. General information

NPI: 1306209606
Provider Name (Legal Business Name): LINCOLN COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 STREET
HUGO CO
80821-2002
US

IV. Provider business mailing address

PO BOX 248 111 6TH STREET
HUGO CO
80821-0248
US

V. Phone/Fax

Practice location:
  • Phone: 719-743-2155
  • Fax:
Mailing address:
  • Phone: 719-743-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW992784
License Number StateCO

VIII. Authorized Official

Name: MRS. SUSAN PETERSEN
Title or Position: HUMAN RESOURCES
Credential:
Phone: 719-931-8012