Provider Demographics
NPI:1457376733
Name:COLORADO FAYETTE MEDICAL CENTER
Entity Type:Organization
Organization Name:COLORADO FAYETTE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GULARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-725-9531
Mailing Address - Street 1:400 YOUENS DR
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962-3680
Mailing Address - Country:US
Mailing Address - Phone:979-725-9531
Mailing Address - Fax:979-725-8132
Practice Address - Street 1:400 YOUENS DR
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962-3680
Practice Address - Country:US
Practice Address - Phone:979-725-9531
Practice Address - Fax:979-725-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000005282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112700302Medicaid
TXHH0466OtherBCBS PROVIDER NUMBER
TX282NR1301XMedicaid
TXHH9604OtherBCBS HOME HEALTH
TX112700301Medicaid
TX112700303Medicaid
458533Medicare Oscar/Certification
TX0077AEMedicare PIN
TX112700303Medicaid
TX112700301Medicaid
TX282NR1301XMedicaid
453405Medicare Oscar/Certification
TX450438Medicare Oscar/Certification
TX00F58EMedicare Oscar/Certification
TXHH9604OtherBCBS HOME HEALTH
TXHH0466OtherBCBS PROVIDER NUMBER
TX00C59HMedicare Oscar/Certification
TXCT1907Medicare PIN