Healthcare Provider Details

I. General information

NPI: 1912349465
Provider Name (Legal Business Name): HIGH PLAINS COMMUNITY HEALTH CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MAIN
WILEY CO
81092
US

IV. Provider business mailing address

201 KENDALL DR
LAMAR CO
81052-3939
US

V. Phone/Fax

Practice location:
  • Phone: 719-829-4286
  • Fax: 719-829-4288
Mailing address:
  • Phone: 719-336-0261
  • Fax: 719-336-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JAY BROOKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-336-0261