Provider Demographics
NPI:1225347339
Name:MONTROSE COUNTY SCHOOL DISTRICT RE-1J
Entity Type:Organization
Organization Name:MONTROSE COUNTY SCHOOL DISTRICT RE-1J
Other - Org Name:NORTHSIDE CHILD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-252-7921
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-249-3700
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:528 N UNCOMPAHGRE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3127
Practice Address - Country:US
Practice Address - Phone:970-240-6438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTROSE COUNTY SCHOOL DISTRICT RE-1J
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-07
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83121285Medicaid
CO05134064Medicaid