Organization
COUNTY OF FREMONT
Active
Other names
Fremont County Department of Public Health & Environment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICK A MIKLICH (DIRECTOR)
(719) 276-7449
Entity
Organization
Contact information
Practice address
201 N 6TH ST, CANON CITY, CO 81212-3303
(719) 276-7450
(719) 276-7451
Mailing address
201 N 6TH ST, CANON CITY, CO 81212-3303
(719) 276-7450
(719) 276-7451
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04446092
—
CO
01
—
COB5228
MEDICARE 73 MASS IMMUNIZATION ROSTER BILLER
CO
Enumeration date
07/21/2005
Last updated
05/08/2017
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