Basic Information
| Provider Information | |||||||||
| NPI: | 1487033874 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SALIDA HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | HEART OF THE ROCKIES REGIONAL MEDICAL CTR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 W HWY 50 | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812012238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302000 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 US HIGHWAY 24 | ||||||||
| Address2: | |||||||||
| City: | LEADVILLE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804613978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302000 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2015 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | FAGERBERG | ||||||||
| AuthorizedOfficialFirstName: | LESLEY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7195302213 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.