Healthcare Provider Details

I. General information

NPI: 1669565677
Provider Name (Legal Business Name): SOUTHEAST COLORADO HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CHURCH ST
SPRINGFIELD CO
81073-1636
US

IV. Provider business mailing address

373 E 10TH AVE
SPRINGFIELD CO
81073-1622
US

V. Phone/Fax

Practice location:
  • Phone: 719-523-6628
  • Fax: 719-523-4513
Mailing address:
  • Phone: 719-523-6628
  • Fax: 719-523-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLA FORREST
Title or Position: HIM DIRECTOR
Credential:
Phone: 719-523-2125