Provider Demographics
NPI:1972608321
Name:KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Entity type:Organization
Organization Name:KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-346-5311
Mailing Address - Street 1:286 16TH STREET B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807
Mailing Address - Country:US
Mailing Address - Phone:719-346-5311
Mailing Address - Fax:719-346-5647
Practice Address - Street 1:286 16TH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807
Practice Address - Country:US
Practice Address - Phone:719-346-5311
Practice Address - Fax:719-346-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1051251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05800396Medicaid
CO05800396Medicaid
CO061543Medicare Oscar/Certification