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General NPI Number Information
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NPI Number | 1922250976
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Entity Type | Organization
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Legal Business Name | COUNTY COMMISSIONERS OF BACA
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 741 MAIN ST SUITE #4
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City | SPRINGFIELD
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State | CO
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Zip | 81073-1548
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Country | US
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Telephone | 719-523-6621
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Fax | 719-523-6537
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Provider Business Mailing Address
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Address Line | 741 MAIN ST SUITE #4
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City | SPRINGFIELD
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State | CO
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Zip | 81073-1548
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Country | US
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Telephone | 719-523-6621
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Fax | 719-523-6537
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | MS. ROBIN TRUJILLO
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Credential | RN
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Telephone | 719-523-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 172848
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License Number State | CO
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