Provider Demographics
NPI:1790912764
Name:PROWERS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PROWERS COUNTY HOSPITAL DISTRICT
Other - Org Name:PROWERS MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIGHTENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-4343
Mailing Address - Street 1:401 KENDALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3942
Mailing Address - Country:US
Mailing Address - Phone:719-336-4343
Mailing Address - Fax:719-336-7207
Practice Address - Street 1:401 KENDALL DRIVE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3942
Practice Address - Country:US
Practice Address - Phone:719-336-4343
Practice Address - Fax:719-336-7207
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROWERS COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-17
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010217332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6195840001Medicare NSC