MEDICARE: NORTHEAST COLORADO HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1144945668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST COLORADO HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	700 COLUMBINE ST
Second Line	:
City	:	STERLING
State	:	CO
Zip	:	80751-3728
Country	:	US
Telephone Number	:	970-522-3741
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 E DENVER ST STE C
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1553
Country	:	US
Telephone Number	:	970-854-2717
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	PENNY STUMPF
Credential	:
Telephone Number	:	970-522-3741

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Practice Location Address:

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1891733879 — EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Practice Location Address:

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