Provider Demographics
NPI:1457749608
Name:KEEFE MEMORIAL HEALTH SERVICE DISTRICT
Entity Type:Organization
Organization Name:KEEFE MEMORIAL HEALTH SERVICE DISTRICT
Other - Org Name:KIT CARSON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLSAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-767-5661
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE WELLS
Mailing Address - State:CO
Mailing Address - Zip Code:80810-0578
Mailing Address - Country:US
Mailing Address - Phone:719-767-5661
Mailing Address - Fax:719-767-8042
Practice Address - Street 1:102 E 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:KIT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80825
Practice Address - Country:US
Practice Address - Phone:719-962-3501
Practice Address - Fax:719-962-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health