Provider Demographics
NPI:1174515258
Name:COUNTY OF WELD BOARD OF COUNTY COMMISSIONERS
Entity type:Organization
Organization Name:COUNTY OF WELD BOARD OF COUNTY COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-400-2293
Mailing Address - Street 1:1555 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9117
Mailing Address - Country:US
Mailing Address - Phone:970-304-6410
Mailing Address - Fax:970-304-6412
Practice Address - Street 1:1555 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9117
Practice Address - Country:US
Practice Address - Phone:970-304-6410
Practice Address - Fax:970-304-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOO.0000241261QP0905X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000119877Medicaid
COAMIS643628OtherBLUE CROSS BLUE SHIELD
CO04005542Medicaid
CO04421095Medicaid
CO57780064Medicaid
CO04421095Medicaid
COAMIS643628OtherBLUE CROSS BLUE SHIELD
CO30496Medicare ID - Type UnspecifiedROSTER BILLING