Provider Demographics
NPI:1033448170
Name:PROWERS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PROWERS COUNTY HOSPITAL DISTRICT
Other - Org Name:LAS ANIMAS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-5147
Mailing Address - Street 1:401 KENDALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3942
Mailing Address - Country:US
Mailing Address - Phone:719-336-5573
Mailing Address - Fax:719-336-8370
Practice Address - Street 1:215 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1029
Practice Address - Country:US
Practice Address - Phone:719-456-6000
Practice Address - Fax:719-456-9701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROWERS COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-21
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010217261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center