Provider Demographics
NPI:1629521539
Name:DCMH URGENT CARE
Entity Type:Organization
Organization Name:DCMH URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-874-2256
Mailing Address - Street 1:PO BOX 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-874-7696
Mailing Address - Fax:970-874-6325
Practice Address - Street 1:155 STAFFORD LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2229
Practice Address - Country:US
Practice Address - Phone:970-874-7696
Practice Address - Fax:970-874-6325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X, 261QU0200X
CO011145282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO063411OtherMEDICARE RHC NUMBER
CO04825048Medicaid