Provider Demographics
NPI:1235562117
Name:HARTSHORN HEALTH SERVICE
Entity Type:Organization
Organization Name:HARTSHORN HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:970-491-1470
Mailing Address - Street 1:8301 CAMPUS DELIVERY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-8031
Mailing Address - Country:US
Mailing Address - Phone:970-491-7121
Mailing Address - Fax:970-491-0226
Practice Address - Street 1:8301 CAMPUS DELIVERY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-8031
Practice Address - Country:US
Practice Address - Phone:970-491-7121
Practice Address - Fax:970-491-0226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0832261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center