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NPI Code Detail

MEDICARE: PLATEAU VALLEY HOSPITAL DISTRICT

MEDICARE: PLATEAU VALLEY HOSPITAL DISTRICT
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2PLR3408OTHERCOBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609990928
Entity Type Code : Organization
Provider Name (Legal Business Name) : PLATEAU VALLEY HOSPITAL DISTRICT
Provider Business Mailing Address
First Line : 58128 HIGHWAY 330
Second Line :
City : COLLBRAN
State : CO
Zip : 81624-9502
Country : US
Telephone Number : 970-487-3565
Fax Number :
Provider Business Practice Location Address
First Line : 58128 HIGHWAY 330
Second Line :
City : COLLBRAN
State : CO
Zip : 81624-9502
Country : US
Telephone Number : 970-487-3565
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : JESSIE CLARK
Credential :
Telephone Number : 970-487-3565
Provider Enumeration Date : 03/19/2007
Last Update Date : 06/07/2022

Similar Medicare Providers

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Practice Location Address:
58128 HIGHWAY 330
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81624-9502
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1114075587 — ERIKA WOODYARD MD
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1902954373 — SCOTT E ROLLINS MD
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1871753434 — ERIN M ARTHUR MD
Practice Location Address:
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COLLBRAN, CO
81624-9502
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1841631975 — DEBORAH NICOLE BORREGO RN, FNP-BC, ACNPC-AG
Practice Location Address:
58128 HIGHWAY 330
COLLBRAN, CO
81624-9502
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Practice Fax:
1306407168 — BETH LYNN HEDSTROM AGACNP-BC FNP-BC APN
Practice Location Address:
58128 HIGHWAY 330
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81624-9502
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Practice Fax:

Directions to “PLATEAU VALLEY HOSPITAL DISTRICT ” Practice Location

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