Provider Demographics
NPI:1932596350
Name:HIGH PLAINS COMMUNITY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:HIGH PLAINS COMMUNITY HEALTH CENTER INCORPORATED
Other - Org Name:HIGH PLAINS HOLLY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-0261
Mailing Address - Street 1:201 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3939
Mailing Address - Country:US
Mailing Address - Phone:719-336-0261
Mailing Address - Fax:719-336-0265
Practice Address - Street 1:410 WEST COLORADO
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:CO
Practice Address - Zip Code:81047
Practice Address - Country:US
Practice Address - Phone:719-336-0261
Practice Address - Fax:719-336-0265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH PLAINS COMMUNITY HEALTH CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)