Provider Demographics
NPI:1972028298
Name:STEAMBOAT EP PLLC
Entity Type:Organization
Organization Name:STEAMBOAT EP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:970-846-6230
Mailing Address - Street 1:1600 MID VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-9006
Mailing Address - Country:US
Mailing Address - Phone:970-846-6230
Mailing Address - Fax:
Practice Address - Street 1:1600 MID VALLEY DR
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-9006
Practice Address - Country:US
Practice Address - Phone:970-846-6230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1972028298OtherCOMMUNITY CLINIC AND EMERGENCY CENTER