Provider Demographics
NPI:1932211596
Name:KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Entity Type:Organization
Organization Name:KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Other - Org Name:PARKE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-346-9481
Mailing Address - Street 1:182 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1649
Mailing Address - Country:US
Mailing Address - Phone:719-346-9481
Mailing Address - Fax:719-346-9485
Practice Address - Street 1:182 16TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1649
Practice Address - Country:US
Practice Address - Phone:719-346-9481
Practice Address - Fax:719-346-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0905261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC248008OtherMEDICARE PART B GROUP
CO48557226Medicaid
CO06-3997Medicare PIN