Provider Demographics
NPI:1013917921
Name:COUNTY OF FREMONT
Entity Type:Organization
Organization Name:COUNTY OF FREMONT
Other - Org Name:FREMONT COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-276-7449
Mailing Address - Street 1:201 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3303
Mailing Address - Country:US
Mailing Address - Phone:719-276-7450
Mailing Address - Fax:719-276-7451
Practice Address - Street 1:201 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3303
Practice Address - Country:US
Practice Address - Phone:719-276-7450
Practice Address - Fax:719-276-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04446092Medicaid
COCOB5228OtherMEDICARE 73 MASS IMMUNIZATION ROSTER BILLER
CO067014Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER
CO05714001Medicaid