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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1275119919
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	:	970-522-1412

Provider Business Practice Location Address
First Line	:	529 N ALBANY ST
Second Line	:	STE 1120
City	:	YUMA
State	:	CO
Zip	:	80759-1526
Country	:	US
Telephone Number	:	970-522-3741
Fax Number	:	970-522-1412

Authorized Official
Title or Position	:	PUBLIC HEALTH DIRECTOR
Name	:	PATRICIA LAYNE MCCLAIN
Credential	:
Telephone Number	:	970-867-4918

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	10/04/2022

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