Provider Demographics
NPI:1467581470
Name:PARK HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PARK HOSPITAL DISTRICT
Other - Org Name:ESTES PARK HEALTH PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:STOCKER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-577-4357
Mailing Address - Street 1:555 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6312
Mailing Address - Country:US
Mailing Address - Phone:970-586-2200
Mailing Address - Fax:970-577-4536
Practice Address - Street 1:555 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:970-586-2200
Practice Address - Fax:970-577-4536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR33113152W00000X
COCO36188207Q00000X
COCO37272207Q00000X
COCO31317207Q00000X
CO36312207Q00000X
COCO38348207R00000X
FLDR47153207R00000X
CODR40558207RA0000X
COCO34193207V00000X
COCO40219208000000X
CODR31069208000000X
COCO30789208600000X
CODR30819208600000X
CODR45845208D00000X
COPA-2781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15587762Medicaid
CO15587762Medicaid