Provider Demographics
NPI:1033374756
Name:HAXTUN HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HAXTUN HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SCHRAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-774-6301
Mailing Address - Street 1:235 W FLETCHER
Mailing Address - Street 2:
Mailing Address - City:HAXTUN
Mailing Address - State:CO
Mailing Address - Zip Code:80731-2737
Mailing Address - Country:US
Mailing Address - Phone:970-774-6123
Mailing Address - Fax:970-774-6158
Practice Address - Street 1:235 W FLETCHER
Practice Address - Street 2:
Practice Address - City:HAXTUN
Practice Address - State:CO
Practice Address - Zip Code:80731-2737
Practice Address - Country:US
Practice Address - Phone:970-774-6123
Practice Address - Fax:970-774-6158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAXTUN HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010112275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86171283Medicaid