Provider Demographics
NPI:1598832966
Name:TRI-COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:TRI-COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-220-9200
Mailing Address - Street 1:6162 S. WILLOW DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5114
Mailing Address - Country:US
Mailing Address - Phone:303-220-9200
Mailing Address - Fax:303-220-9208
Practice Address - Street 1:6162 S. WILLOW DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5114
Practice Address - Country:US
Practice Address - Phone:303-220-9200
Practice Address - Fax:303-220-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19553251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16903757Medicaid