MEDICARE: COUNTY OF CLEAR CREEK

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255470225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF CLEAR CREEK

Provider Business Mailing Address
First Line	:	PO BOX 3669
Second Line	:
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452-3669
Country	:	US
Telephone Number	:	303-567-3147
Fax Number	:	303-567-3132

Provider Business Practice Location Address
First Line	:	1969 MINER STREET
Second Line	:
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452
Country	:	US
Telephone Number	:	970-409-2577
Fax Number	:

Authorized Official
Title or Position	:	NURSING SUPERVISOR
Name	:	EMILY KUPER
Credential	:	APRN
Telephone Number	:	970-409-2577

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/10/2023

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Directions to “COUNTY OF CLEAR CREEK ” Practice Location

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