Healthcare Provider Details

I. General information

NPI: 1831294867
Provider Name (Legal Business Name): OTERO COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 W 3RD ST ROOM 111 COUNTY COURTHOUSE
LA JUNTA CO
81050-1536
US

IV. Provider business mailing address

13 W 3RD ST ROOM 111 COUNTY COURTHOUSE
LA JUNTA CO
81050-1536
US

V. Phone/Fax

Practice location:
  • Phone: 719-383-3040
  • Fax: 719-383-3060
Mailing address:
  • Phone: 719-383-3040
  • Fax: 719-383-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251K00000X
License Number StateCO

VIII. Authorized Official

Name: MR. RICHARD RITTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-383-3045