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Provider Information for 1518060672


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UNIV OF N CO STUDENT HLTH CTR

Organization Subpart: NO

NPI: 1518060672
Last Updated: 2020-08-22
Certification Date:

Details

NameValue
NPI1518060672
Enumeration Date2006-09-06
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: ROGER POMEROY MSPT
Title: DIR OF REHAB SVCS UNC ST HLTH
Phone: 9703922431
Mailing Address 1901 10TH AVE
CASSIDY HALL
GREELEY, CO 80631
United States

Phone: | Fax:
 
Primary Practice Address 1901 10TH AVE
CASSIDY HALL
GREELEY, CO 80631
United States

Phone: 970-351-2412 | Fax:970-350-4953
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)0620042Other ID Number-Commercial Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0002X - Pharmacy - Clinic PharmacyCO235