Provider Demographics
NPI:1598359218
Name:COUNTY OF WELD
Entity Type:Organization
Organization Name:COUNTY OF WELD
Other - Org Name:WELD COUNTY PUBLIC HEALTH SOUTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-400-2116
Mailing Address - Street 1:1555 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9117
Mailing Address - Country:US
Mailing Address - Phone:970-304-6410
Mailing Address - Fax:
Practice Address - Street 1:4209 COUNTY ROAD 24 1/2
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5273
Practice Address - Country:US
Practice Address - Phone:970-304-6410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-23
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04421095Medicaid