Basic Information
Provider Information | |||||||||
NPI: | 1285102491 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CATHOLIC HEALTH INITIATIVES COLORADO | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BRECKENRIDGE EMERGENCY AND URGENT CARE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 911057 | ||||||||
Address2: |   | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802911057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8882697001 | ||||||||
FaxNumber: | 3037646640 | ||||||||
Practice Location | |||||||||
Address1: | 555 S PARK AVE PLAZA II | ||||||||
Address2: |   | ||||||||
City: | BRECKENRIDGE | ||||||||
State: | CO | ||||||||
PostalCode: | 804240000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9704531010 | ||||||||
FaxNumber: | 9704535407 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/06/2018 | ||||||||
LastUpdateDate: | 11/01/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SKINNER | ||||||||
AuthorizedOfficialFirstName: | ANGELA | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINISTRATOR, OMA | ||||||||
AuthorizedOfficialTelephone: | 3036737175 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QE0002X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.