Organization
COUNTY OF WELD BOARD OF COUNTY COMMISSIONERS
Active
Other names
Weld County Dept of Public Health & Environment Independent Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E WALLACE M.D., M.P.H. (EXECUTIVE DIRECTOR)
(970) 304-6410
Entity
Organization
Contact information
Practice address
1555 N 17TH AVE, 2ND FLOOR, ENVIRONMENTAL HEALTH, GREELEY, CO 80631-9117
(970) 304-6410
Mailing address
1555 N 17TH AVE, GREELEY, CO 80631-9117
(970) 304-6410
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
06D0665967
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06D0665967
CMS CLIA
CO
05
—
35628545
—
CO
Enumeration date
06/23/2016
Last updated
01/05/2017
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