Healthcare Provider Details

I. General information

NPI: 1174511414
Provider Name (Legal Business Name): PROWERS COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KENDALL DRIVE
LAMAR CO
81052-3942
US

IV. Provider business mailing address

401 KENDALL DRIVE
LAMAR CO
81052-3942
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-6881
  • Fax: 719-336-7089
Mailing address:
  • Phone: 719-336-4343
  • Fax: 719-336-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0402RX
License Number StateCO

VIII. Authorized Official

Name: KAREN L BRYANT
Title or Position: C.O.O.
Credential:
Phone: 719-336-5147