Provider Demographics
NPI:1386675619
Name:WASHINGTON COUNTY COLORADO
Entity Type:Organization
Organization Name:WASHINGTON COUNTY COLORADO
Other - Org Name:WASHINGTON COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-345-2701
Mailing Address - Street 1:482 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:CO
Mailing Address - Zip Code:80720-1149
Mailing Address - Country:US
Mailing Address - Phone:970-345-2262
Mailing Address - Fax:970-345-2265
Practice Address - Street 1:482 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:CO
Practice Address - Zip Code:80720-1149
Practice Address - Country:US
Practice Address - Phone:970-345-2262
Practice Address - Fax:970-345-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO063868Medicare Oscar/Certification