Provider Demographics
NPI:1578720918
Name:TELLER COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:TELLER COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:719-687-6416
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:11115 W HWY 24 UNIT 2-C
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-0928
Mailing Address - Country:US
Mailing Address - Phone:719-687-6416
Mailing Address - Fax:719-687-6501
Practice Address - Street 1:11115 W HWY 24 RD
Practice Address - Street 2:UNIT 2C
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814
Practice Address - Country:US
Practice Address - Phone:719-687-6416
Practice Address - Fax:719-687-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04540548Medicaid