Provider Demographics
NPI:1093745804
Name:STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Entity Type:Organization
Organization Name:STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-692-2012
Mailing Address - Street 1:4300 CHERRY CREEK SOUTH DR
Mailing Address - Street 2:ATTN: PRIVACY OFFICER A-5
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1530
Mailing Address - Country:US
Mailing Address - Phone:303-692-2311
Mailing Address - Fax:
Practice Address - Street 1:4300 CHERRY CREEK SOUTH DR
Practice Address - Street 2:ATTN: PRIVACY OFFICER A-5
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1530
Practice Address - Country:US
Practice Address - Phone:303-692-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare