Provider Demographics
NPI:1952322315
Name:LONGMONT UNITED HOSPITAL
Entity Type:Organization
Organization Name:LONGMONT UNITED HOSPITAL
Other - Org Name:UNITED MEDICAL CENTER OF BERTHOUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-651-5024
Mailing Address - Street 1:1950 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3129
Mailing Address - Country:US
Mailing Address - Phone:303-651-5111
Mailing Address - Fax:303-678-4050
Practice Address - Street 1:549 MOUNTAIN AVENUE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513
Practice Address - Country:US
Practice Address - Phone:970-532-4644
Practice Address - Fax:970-532-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0931261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05020011Medicaid
CO05020011Medicaid
COCC6298Medicare PIN