Provider Demographics
NPI:1912232349
Name:PROWERS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PROWERS COUNTY HOSPITAL DISTRICT
Other - Org Name:CONVENIENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-5147
Mailing Address - Street 1:403 KENDALL DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3953
Mailing Address - Country:US
Mailing Address - Phone:719-336-6767
Mailing Address - Fax:719-336-7217
Practice Address - Street 1:403 KENDALL DR STE C
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3953
Practice Address - Country:US
Practice Address - Phone:719-336-6767
Practice Address - Fax:719-336-7217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROWERS COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO068510Medicare Oscar/Certification
COPENDINGMedicare Oscar/Certification