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NPI Code Detail

MEDICARE: COLORADO MENTAL HEALTH INSTITUTE FORT LOGAN

MEDICARE: COLORADO MENTAL HEALTH INSTITUTE FORT LOGAN
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
13336I0012XInstitutional PharmacyCO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10602943OTHERCONCPDP MEDICARE PART D

General Provider Information

NPI Number : 1689733479
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLORADO MENTAL HEALTH INSTITUTE FORT LOGAN
Provider Business Mailing Address
First Line : 1600 W 24TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-1411
Country : US
Telephone Number : 719-546-4000
Fax Number : 719-546-4484
Provider Business Practice Location Address
First Line : 3520 W OXFORD AVE
Second Line :
City : DENVER
State : CO
Zip : 80236-3108
Country : US
Telephone Number : 303-866-7149
Fax Number :
Authorized Official
Title or Position : COMPLIANCE OFFICER
Name : KAT FOO
Credential :
Telephone Number : 303-866-5871
Provider Enumeration Date : 12/07/2006
Last Update Date : 08/22/2020

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Directions to “COLORADO MENTAL HEALTH INSTITUTE FORT LOGAN ” Practice Location

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