Healthcare Provider Details

I. General information

NPI: 1265025712
Provider Name (Legal Business Name): KIT CARSON COUNTY HEALTH SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101B COLORADO AVE
SEIBERT CO
80834-5002
US

IV. Provider business mailing address

101B COLORADO AVE
SEIBERT CO
80834-5002
US

V. Phone/Fax

Practice location:
  • Phone: 970-664-2507
  • Fax: 719-346-5459
Mailing address:
  • Phone: 970-664-2507
  • Fax: 719-346-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRENDA L BRIEGEL
Title or Position: DIRECTORY
Credential:
Phone: 719-346-9481