Provider Demographics
NPI:1205871092
Name:LONGMONT UNITED HOSPITAL
Entity type:Organization
Organization Name:LONGMONT UNITED HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-651-5023
Mailing Address - Street 1:1551 PROFESSIONAL LN
Mailing Address - Street 2:UNIT 155
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6972
Mailing Address - Country:US
Mailing Address - Phone:303-651-5225
Mailing Address - Fax:720-494-4748
Practice Address - Street 1:1551 PROFESSIONAL LN
Practice Address - Street 2:UNIT 155
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6972
Practice Address - Country:US
Practice Address - Phone:303-651-5225
Practice Address - Fax:720-494-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0931251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05700398Medicaid
CO067139Medicare ID - Type Unspecified