Healthcare Provider Details

I. General information

NPI: 1467400309
Provider Name (Legal Business Name): TRINIDAD AREA HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BENEDICTA AVE
TRINIDAD CO
81082-2099
US

IV. Provider business mailing address

410 BENEDICTA AVENUE
TRINIDAD CO
81082
US

V. Phone/Fax

Practice location:
  • Phone: 719-845-3168
  • Fax: 719-845-4243
Mailing address:
  • Phone: 719-846-9213
  • Fax: 719-845-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: KATHY TOPPING
Title or Position: PFS DIRECTORE
Credential:
Phone: 719-845-3168