Provider Demographics
NPI:1427328426
Name:SOUTH PLATTE RIVER HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:SOUTH PLATTE RIVER HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MEINTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-867-4997
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2106
Mailing Address - Country:US
Mailing Address - Phone:970-867-4997
Mailing Address - Fax:970-967-8430
Practice Address - Street 1:603 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2919
Practice Address - Country:US
Practice Address - Phone:970-867-4997
Practice Address - Fax:970-867-8430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH PLATTE RIVER HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19871540393332BP3500X, 332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08839532Medicaid
CO0307740001Medicare NSC