Provider Demographics
NPI:1033281514
Name:KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Entity Type:Organization
Organization Name:KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Other - Org Name:KIT CARSON COUNTY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:719-346-4721
Mailing Address - Street 1:286 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1651
Mailing Address - Country:US
Mailing Address - Phone:719-346-4721
Mailing Address - Fax:719-346-5647
Practice Address - Street 1:286 16TH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1651
Practice Address - Country:US
Practice Address - Phone:719-346-4721
Practice Address - Fax:719-346-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0905275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06Z313Medicare ID - Type Unspecified