Provider Demographics
NPI:1366593196
Name:FREMONT COUNTY
Entity type:Organization
Organization Name:FREMONT COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-275-2318
Mailing Address - Street 1:172 JUSTICE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9354
Mailing Address - Country:US
Mailing Address - Phone:719-275-2318
Mailing Address - Fax:719-275-5206
Practice Address - Street 1:172 JUSTICE CENTER RD
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9354
Practice Address - Country:US
Practice Address - Phone:719-275-2318
Practice Address - Fax:719-275-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09000225251B00000X
CO06200224343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06200224Medicaid
CO09000225Medicaid