Provider Demographics
NPI:1497884845
Name:MONTEZUMA-CORTEZ SCHOOL DISTRICT RE-1
Entity Type:Organization
Organization Name:MONTEZUMA-CORTEZ SCHOOL DISTRICT RE-1
Other - Org Name:CORTEZ SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-588-0397
Mailing Address - Street 1:PO BOX R
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-0708
Mailing Address - Country:US
Mailing Address - Phone:970-565-7282
Mailing Address - Fax:
Practice Address - Street 1:400 N ELM ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2736
Practice Address - Country:US
Practice Address - Phone:970-565-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45974764Medicaid