Provider Demographics
NPI:1043920887
Name:BENT COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:BENT COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-456-0517
Mailing Address - Street 1:701 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-1575
Mailing Address - Country:US
Mailing Address - Phone:719-456-0517
Mailing Address - Fax:
Practice Address - Street 1:701 S PARK AVE
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1575
Practice Address - Country:US
Practice Address - Phone:719-456-0517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05715008Medicaid