Provider Demographics
NPI:1821052929
Name:PROWERS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PROWERS COUNTY HOSPITAL DISTRICT
Other - Org Name:PROWERS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-5147
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
CO010217282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05007000Medicaid
CO05007000Medicaid
CO06Z323Medicare Oscar/Certification