Provider Demographics
NPI:1093945685
Name:WIN HBO
Entity type:Organization
Organization Name:WIN HBO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CHWS,DMT-A,BS
Authorized Official - Phone:970-927-4950
Mailing Address - Street 1:1460 E VALLEY RD
Mailing Address - Street 2:104
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8411
Mailing Address - Country:US
Mailing Address - Phone:970-927-4950
Mailing Address - Fax:877-433-2364
Practice Address - Street 1:1460 E VALLEY RD
Practice Address - Street 2:104
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8411
Practice Address - Country:US
Practice Address - Phone:970-384-8447
Practice Address - Fax:970-384-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty