Provider Demographics
NPI:1366465866
Name:LONGMONT UNITED HOSPITAL
Entity Type:Organization
Organization Name:LONGMONT UNITED HOSPITAL
Other - Org Name:LONGMONT UNITED HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP CFO
Authorized Official - Prefix:
Authorized Official - First Name:TADD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-571-7202
Mailing Address - Street 1:1950 W MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3129
Mailing Address - Country:US
Mailing Address - Phone:303-651-5111
Mailing Address - Fax:303-678-4050
Practice Address - Street 1:1950 W MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3129
Practice Address - Country:US
Practice Address - Phone:303-651-5111
Practice Address - Fax:303-678-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
CO010350282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04003158OtherMEDICAID PROFESSIONAL COMPENSATION
CO05003009Medicaid
CO05003009Medicaid
CO06-0003Medicare Oscar/Certification
COCC6298Medicare PIN
CO04003158OtherMEDICAID PROFESSIONAL COMPENSATION