Basic Information
| Provider Information | |||||||||
| NPI: | 1992037048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTROSE COUNTY SCHOOL DISTRICT NO. RE-1J | ||||||||
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| OtherOrganizationName: | OLATHE SCHOOL COMMUNITY HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702493700 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 NORTH ROBERTS | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703236141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2010 | ||||||||
| LastUpdateDate: | 01/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | SLATER | ||||||||
| AuthorizedOfficialFirstName: | KARIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9702527901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2905 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.