Provider Demographics
NPI:1972670461
Name:SOUTHERN COLORADO UTE SERVICE UNIT
Entity type:Organization
Organization Name:SOUTHERN COLORADO UTE SERVICE UNIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-4441
Mailing Address - Street 1:PO BOX 95450
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-0033
Mailing Address - Country:US
Mailing Address - Phone:970-565-4441
Mailing Address - Fax:970-565-4784
Practice Address - Street 1:232 RUSTLING WILLOW
Practice Address - Street 2:
Practice Address - City:TOWAOC
Practice Address - State:CO
Practice Address - Zip Code:81334
Practice Address - Country:US
Practice Address - Phone:970-565-4441
Practice Address - Fax:970-565-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67123Medicaid
UT700000000009Medicaid
2003393OtherPK
AZ708000Medicaid
CO43205542Medicaid