Provider Demographics
NPI:1831294867
Name:OTERO COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:OTERO COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-383-3045
Mailing Address - Street 1:13 W 3RD ST
Mailing Address - Street 2:ROOM 111 COUNTY COURTHOUSE
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1536
Mailing Address - Country:US
Mailing Address - Phone:719-383-3040
Mailing Address - Fax:719-383-3060
Practice Address - Street 1:13 W 3RD ST
Practice Address - Street 2:ROOM 111 COUNTY COURTHOUSE
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1536
Practice Address - Country:US
Practice Address - Phone:719-383-3040
Practice Address - Fax:719-383-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31546Medicare UPIN