Healthcare Provider Details

I. General information

NPI: 1427601848
Provider Name (Legal Business Name): SALIDA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RUSH DR
SALIDA CO
81201-9627
US

IV. Provider business mailing address

PO BOX 429
SALIDA CO
81201-0429
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-2401
  • Fax:
Mailing address:
  • Phone: 719-530-2213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LESLEY FAGERBERG
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 719-530-2213