Basic Information
| Provider Information | |||||||||
| NPI: | 1740795251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALIDA HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | HEART OF THE ROCKIES REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 429 | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812010429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302213 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 RUSH DR | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812019669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2017 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | FAGERBERG | ||||||||
| AuthorizedOfficialFirstName: | LESLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7195302213 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.