Provider Demographics
NPI:1285727297
Name:SOUTHEAST COLORADO HOSPITAL DISTRICT
Entity type:Organization
Organization Name:SOUTHEAST COLORADO HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-523-2125
Mailing Address - Street 1:373 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1622
Mailing Address - Country:US
Mailing Address - Phone:719-523-4501
Mailing Address - Fax:719-523-4290
Practice Address - Street 1:373 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:CO
Practice Address - Zip Code:81073-1622
Practice Address - Country:US
Practice Address - Phone:719-523-4501
Practice Address - Fax:719-523-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QC0050X, 275N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO010221OtherCOLORADO LICENSE NUMBER
CO05085006Medicaid
CO06Z311OtherMEDICARE SKILLED
06Z311Medicare Oscar/Certification