=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124659859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHOLIC HEALTH INITIATIVES COLORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2020
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 760 WARNER DR
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-5297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-925-4360
-----------------------------------------------------
Fax | 303-925-4361
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 800022
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64180-0022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-953-0104
-----------------------------------------------------
Fax | 303-675-6670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, AMBULATORY SERVICES
-----------------------------------------------------
Name | MS. DEBRA CARPENTER CARPENTER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 303-765-6998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------