Provider Demographics
NPI:1982835294
Name:CATHOLIC HEALTH INIATIVES COLORADO
Entity Type:Organization
Organization Name:CATHOLIC HEALTH INIATIVES COLORADO
Other - Org Name:ST THOMAS MORE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN DIR OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMERZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-285-2606
Mailing Address - Street 1:1338 PHAY AVE BLDG D
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2326
Mailing Address - Country:US
Mailing Address - Phone:719-285-2700
Mailing Address - Fax:
Practice Address - Street 1:1338 PHAY AVE BLDG D
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-285-2700
Practice Address - Fax:719-285-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30435536Medicaid