Kit Carson County Health Services District
Organization Active NPI Rural Health Clinic/Center · Stratton, CO
NPI 1124122403 · NPPES record last updated Feb 23, 2021
Key facts
- NPI
- 1124122403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 0905 (CO)
- Legal business name
- KIT CARSON COUNTY HEALTH SERVICES DISTRICT
- Practice address
- 500 Nebraska Ave
Stratton, CO 80836-1366 - Phone
- (719) 348-4650
- Fax
- (719) 348-4653
- NPI assigned
- Sep 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Brenda L Briegel
- Title
- Manager
- Phone
- (719) 346-9481
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 5
Related certifications (CCN) 1
Practitioners 30
-
Krista Shalynn Davis, LCSW
-
Jesus Jaime Perez, M.D.
-
Sacramento Pimentel, M.D.
-
Amanda Folsom, PMHNP
-
Lani Michelle Magee, LCSW
-
Erick Anderson, PA-C
-
Andrew Eric Brookens, M.D.
-
Benjamin Gehret, C.R.N.A.
-
Lauren Elizabeth Gerk, DNP, CRNA
-
Gary D Kliewer, C.R.N.A.
-
W Rafer Leach, M.D.
-
Paul Val Meredith, CRNA
-
Christopher C Moore, C-APN
-
Jacob Oppenheimer, M.D.
-
Jeffrey Wayne Rouse, PA-C
-
Jesse Enoch Smith, APRN
-
Erin Kelly Flynn, PA-C
-
Udo G Foreman, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Rural health clinic certification: CCN 063401
- Legal name
- KIT CARSON COUNTY HEALTH SERVICES DISTRICT
- Doing business as
- STRATTON MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 10, 2001
- Last certification
- Nov 8, 2017
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Enrollment address
- 500 Nebraska Ave
Stratton, CO 80836-1366 - Related CCNs
- 061313
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Brenda Briegel |
Corporate Director |
Jan 1, 2000 | |
| W-2 Managing Employee |
Jan 1, 2000 | ||
| Operational/Managerial Control |
Jan 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080204000700 | CO | Part a Provider - Rural Health Clinic | 4385637917 | Practice locations: Stratton, CO |
National Provider Directory
- Tax ID family
- Kit Carson County Health Service District
Locations
500 Nebraska Ave
Stratton, CO 80836
Phone (719) 348-4650
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 0905 | CO | Yes |
Addresses
Primary practice location
500 Nebraska Ave
Stratton, CO 80836-1366
Mailing address
500 Nebraska Ave
Stratton, CO 80836-1366
Phone (719) 348-4650
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41388330 | Medicaid | CO |
Other names
- Stratton Medical Clinic
Other providers in Stratton, CO
All providers in Stratton, CO · Rural Health Clinic/Center in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.