Provider Demographics
NPI:1124892526
Name:COLORADO MOUNTAIN HEALTH
Entity type:Organization
Organization Name:COLORADO MOUNTAIN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-299-0988
Mailing Address - Street 1:115 S 7TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3782
Mailing Address - Country:US
Mailing Address - Phone:719-299-0988
Mailing Address - Fax:
Practice Address - Street 1:115 S 7TH ST STE 112
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3782
Practice Address - Country:US
Practice Address - Phone:719-299-0988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty