Provider Demographics
NPI:1942366612
Name:COUNTY OF GUNNISON
Entity Type:Organization
Organization Name:COUNTY OF GUNNISON
Other - Org Name:GUNNISON COUNTY PUBLIC HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:970-641-0209
Mailing Address - Street 1:225 N PINE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2648
Mailing Address - Country:US
Mailing Address - Phone:970-641-0209
Mailing Address - Fax:
Practice Address - Street 1:225 N PINE ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2648
Practice Address - Country:US
Practice Address - Phone:970-641-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010880Medicaid
CO04005740Medicaid
CO04010880Medicaid