Healthcare Provider Details

I. General information

NPI: 1427328426
Provider Name (Legal Business Name): SOUTH PLATTE RIVER HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W MAIN ST
STERLING CO
80751-2919
US

IV. Provider business mailing address

201 MAIN ST
FORT MORGAN CO
80701-2106
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-4997
  • Fax: 970-867-8430
Mailing address:
  • Phone: 970-867-4997
  • Fax: 970-967-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number19871540393
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number19871540393
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number19871540393
License Number StateCO

VIII. Authorized Official

Name: MRS. SHARON KAY MEINTS
Title or Position: OWNER
Credential:
Phone: 970-867-4997