Provider Demographics
NPI:1770547440
Name:COUNTY OF ALAMOSA
Entity type:Organization
Organization Name:COUNTY OF ALAMOSA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHIOSHITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-589-6639
Mailing Address - Street 1:8900 INDEPENDENCE WAY
Mailing Address - Street 2:BUILDING B
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9412
Mailing Address - Country:US
Mailing Address - Phone:719-589-6639
Mailing Address - Fax:719-589-1103
Practice Address - Street 1:8900 INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9412
Practice Address - Country:US
Practice Address - Phone:719-589-6639
Practice Address - Fax:719-589-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC30006251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04453098Medicaid
CO04453098Medicaid