Provider Demographics
NPI:1417143587
Name:MINERAL COUNTY PUBLIC HEALTH
Entity type:Organization
Organization Name:MINERAL COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR OF COMMISSIONERS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILBERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-658-2331
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:CREEDE
Mailing Address - State:CO
Mailing Address - Zip Code:81130-0425
Mailing Address - Country:US
Mailing Address - Phone:719-658-2416
Mailing Address - Fax:719-652-3001
Practice Address - Street 1:802 RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:CREEDE
Practice Address - State:CO
Practice Address - Zip Code:81130-0425
Practice Address - Country:US
Practice Address - Phone:719-658-2416
Practice Address - Fax:719-652-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO119862251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare