Provider Demographics
NPI:1124120589
Name:CATHOLIC HEALTH INITIATIVES COLORADO
Entity type:Organization
Organization Name:CATHOLIC HEALTH INITIATIVES COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PHYS ENTERPRISES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-804-8119
Mailing Address - Street 1:DEPARTMENT 1057
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1057
Mailing Address - Country:US
Mailing Address - Phone:303-486-5500
Mailing Address - Fax:303-486-5501
Practice Address - Street 1:41 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-686-0551
Practice Address - Fax:719-686-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04606042Medicaid
C509238Medicare ID - Type Unspecified
CO04606042Medicaid