Provider Demographics
NPI:1720369150
Name:CATHOLIC HEALTH INITIATIVES COLORADO
Entity Type:Organization
Organization Name:CATHOLIC HEALTH INITIATIVES COLORADO
Other - Org Name:TRADITIONAL FAMILY MEDICINE CENTER AT CENTURA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP-FINANCE PE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:HESSELINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-804-8136
Mailing Address - Street 1:P.O. BOX 911057
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1057
Mailing Address - Country:US
Mailing Address - Phone:303-486-5401
Mailing Address - Fax:303-486-5502
Practice Address - Street 1:1925 E. ORMAN AVE.
Practice Address - Street 2:SUITE A-345
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:719-557-3501
Practice Address - Fax:719-557-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802980Medicare PIN