Provider Demographics
NPI:1588803050
Name:WALSH HOSPITAL DISTRICT HEALTHCARE CENTER
Entity Type:Organization
Organization Name:WALSH HOSPITAL DISTRICT HEALTHCARE CENTER
Other - Org Name:WALSH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NHA
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:719-324-5262
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:WALSH
Mailing Address - State:CO
Mailing Address - Zip Code:81090-0206
Mailing Address - Country:US
Mailing Address - Phone:719-324-5262
Mailing Address - Fax:719-324-5266
Practice Address - Street 1:137 KANSAS STREET
Practice Address - Street 2:
Practice Address - City:WALSH
Practice Address - State:CO
Practice Address - Zip Code:81090
Practice Address - Country:US
Practice Address - Phone:719-324-5253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALSH HOSPITAL DISTRICT HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-06
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86231871Medicaid
CO063874Medicare PIN