Provider Demographics
NPI:1629344908
Name:SOUTHERN COLORADO UTE SERVICE UNIT
Entity Type:Organization
Organization Name:SOUTHERN COLORADO UTE SERVICE UNIT
Other - Org Name:WHITE MESA HEALTH STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH CENTER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-4441
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:TOWAOC
Mailing Address - State:CO
Mailing Address - Zip Code:81334-0049
Mailing Address - Country:US
Mailing Address - Phone:970-565-4441
Mailing Address - Fax:970-565-9110
Practice Address - Street 1:232 RUSTLING WILLOW ST
Practice Address - Street 2:
Practice Address - City:TOWAOC
Practice Address - State:CO
Practice Address - Zip Code:81334-0049
Practice Address - Country:US
Practice Address - Phone:970-565-4441
Practice Address - Fax:970-565-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG7123Medicaid
UT70000000009Medicaid
CO05600002Medicaid
AZ708000Medicaid
UT70000000009Medicaid
NM320057Medicare Oscar/Certification