Provider Demographics
NPI:1700861606
Name:PROWERS COUNTY NURSING
Entity Type:Organization
Organization Name:PROWERS COUNTY NURSING
Other - Org Name:PROWERS COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JO LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-8721
Mailing Address - Street 1:1001 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3838
Mailing Address - Country:US
Mailing Address - Phone:719-336-8721
Mailing Address - Fax:719-336-9763
Practice Address - Street 1:1001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3838
Practice Address - Country:US
Practice Address - Phone:719-336-8721
Practice Address - Fax:719-336-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04451092Medicaid
COC30356Medicare ID - Type Unspecified