Basic Information
| Provider Information | |||||||||
| NPI: | 1841582590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CSU HEALTH NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SOUTH DR | ||||||||
| Address2: | HARTSHORN BUILDING | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704917121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 SOUTH DR | ||||||||
| Address2: | HARTSHORN BUILDING | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704917121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2011 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | ELWYN | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9704916602 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COLORADO STATE UNIVERSITY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Student Health |
No ID Information.