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General NPI Number Information
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NPI Number | 1790767192
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Entity Type | Organization
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Legal Business Name | LAKE FORK HEALTH SERVICES DISTRICT
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Dates
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Enumeration Date | 11/19/2005
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 700 N HENSON
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City | LAKE CITY
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State | CO
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Zip | 81235-0999
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Country | US
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Telephone | 970-944-2331
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Fax | 970-944-2320
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | LAKE CITY
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State | CO
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Zip | 81235-0999
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Country | US
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Telephone | 970-944-2331
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Fax | 970-944-2331
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BEUFORD T DURMON
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Credential | MD
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Telephone | 970-944-2331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | CO
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