Healthcare Provider Details

I. General information

NPI: 1750535266
Provider Name (Legal Business Name): WEST CUSTER COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 EDWARDS ST.
WESTCLIFFE CO
81252-8588
US

IV. Provider business mailing address

PO BOX 120
WESTCLIFFE CO
81252
US

V. Phone/Fax

Practice location:
  • Phone: 719-783-2380
  • Fax: 719-783-2377
Mailing address:
  • Phone: 719-783-2380
  • Fax: 719-783-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: TERRY NIMNICHT
Title or Position: CEO
Credential:
Phone: 719-783-2380