Healthcare Provider Details

I. General information

NPI: 1639575954
Provider Name (Legal Business Name): CATHOLIC HEALTH INITIATIVES COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17230 JACKSON CREEK PKWY SUITE 120
MONUMENT CO
80132-7300
US

IV. Provider business mailing address

PO BOX 911057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-7070
  • Fax: 719-571-7079
Mailing address:
  • Phone: 303-643-1099
  • Fax: 303-643-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA SKINNER
Title or Position: OMA / ADMINISTRATOR
Credential:
Phone: 303-673-7175