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General NPI Number Information
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NPI Number | 1306209606
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Entity Type | Organization
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Legal Business Name | LINCOLN COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 116 STREET
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City | HUGO
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State | CO
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Zip | 80821-2002
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Country | US
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Telephone | 719-743-2155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 248 111 6TH STREET
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City | HUGO
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State | CO
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Zip | 80821-0248
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Country | US
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Telephone | 719-743-2421
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Fax |
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Authorized Official
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Title or Position | HUMAN RESOURCES
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Name | MRS. SUSAN PETERSEN
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Credential |
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Telephone | 719-931-8012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW992784
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License Number State | CO
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