Provider Demographics
NPI:1255470225
Name:COUNTY OF CLEAR CREEK
Entity Type:Organization
Organization Name:COUNTY OF CLEAR CREEK
Other - Org Name:CLEAR CREEK COUNTY PUBLIC AND ENVIRONMENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:970-409-2577
Mailing Address - Street 1:PO BOX 3669
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-3669
Mailing Address - Country:US
Mailing Address - Phone:303-567-3147
Mailing Address - Fax:303-567-3132
Practice Address - Street 1:1969 MINER STREET
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452
Practice Address - Country:US
Practice Address - Phone:970-409-2577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04540209Medicaid
CO07382807Medicaid
CO07382807Medicaid