=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992037048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTROSE COUNTY SCHOOL DISTRICT NO. RE-1J
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2010
-----------------------------------------------------
Last Update Date | 01/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 NORTH ROBERTS
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-323-6141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2233 E MAIN ST
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81401-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-249-3700
-----------------------------------------------------
Fax | 970-497-8410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | KARIN SLATER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-252-7901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2905
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------