Provider Demographics
NPI:1073520375
Name:EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-854-2241
Mailing Address - Street 1:1001 E JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-1854
Mailing Address - Country:US
Mailing Address - Phone:970-854-2500
Mailing Address - Fax:970-854-3440
Practice Address - Street 1:1001 E JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-1854
Practice Address - Country:US
Practice Address - Phone:970-854-2500
Practice Address - Fax:970-854-3440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59725877Medicaid
COCC8329OtherRR MCR #
COFA231008OtherBC/BS PROV #
COCC8329OtherRR MCR #
COFA231008OtherBC/BS PROV #