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Organization
CHINOOK HEALTHCARE IN
Active
Organization
CHINOOK HEALTHCARE IN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYSON C HODGE (PRESIDENT)
(720) 458-4887
Entity
Organization
Contact information
Practice address
325 W S BOULDER RD, SUITE 5, LOUISVILLE, CO 80027-1130
(720) 458-4887
(720) 890-6144
Mailing address
325 W S BOULDER RD, SUITE 5, LOUISVILLE, CO 80027-1130
(720) 458-4887
(720) 890-6144
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
NULL
332900000X
Non-Pharmacy Dispensing Site
—
NULL
332BD1200X
Dialysis Equipment & Supplies (DME)
Primary
—
NULL
Other
Enumeration date
10/19/2011
Last updated
10/19/2011
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