MEDICARE: EAST PHILLIPS COUNTY 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
1	282NC0060X	Critical Access Hospital	0586	CO

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

General Provider Information

NPI Number	:	1891733879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST PHILLIPS COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1001 E JOHNSON STREET
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1854
Country	:	US
Telephone Number	:	970-854-2241
Fax Number	:	970-854-3821

Provider Business Practice Location Address
First Line	:	1001 E JOHNSON STREET
Second Line	:
City	:	HOLYOKE
State	:	CO
Zip	:	80734-1854
Country	:	US
Telephone Number	:	970-854-2241
Fax Number	:	970-854-3821

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL HASSELL
Credential	:
Telephone Number	:	970-854-2241

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/06/2024

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