Provider Demographics
NPI:1760851737
Name:HUERFANO COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HUERFANO COUNTY HOSPITAL DISTRICT
Other - Org Name:SPANISH PEAKS FAMILY CLINIC - LA VETA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-738-5137
Mailing Address - Street 1:23500 US HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-9524
Mailing Address - Country:US
Mailing Address - Phone:719-738-5135
Mailing Address - Fax:
Practice Address - Street 1:908 S OAK
Practice Address - Street 2:
Practice Address - City:LA VETA
Practice Address - State:CO
Practice Address - Zip Code:81055-0704
Practice Address - Country:US
Practice Address - Phone:719-742-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
CO010720261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO548520Medicare PIN
CO39385787Medicaid
CO89655761Medicaid
CO061316Medicare Oscar/Certification
CO2083P0901XOtherTAXONOMY