NPIMap

Organization Active NPI

Southeastern Developmental Services

  • Early Intervention Provider Agency
  • Lamar, CO
National Provider Identifier
1407399405
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
SOUTHEASTERN DEVELOPMENTAL SERVICES
Practice address
1111 S 4TH St
Lamar, CO 81052-3804
Phone
(719) 336-3244
Fax
(719) 336-3898
NPI assigned
Nov 22, 2016
Last updated
Nov 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Engsberg
Title
Executive Director
Phone
(719) 336-3244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X Primary

Addresses

Primary practice location

1111 S 4TH St
Lamar, CO 81052-3804

Mailing address

PO Box 328
Lamar, CO 81052-0328
Phone (719) 336-3244

Other identifiers 1

IdentifierTypeStateIssuer
04586719MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
S E Developmental Services Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479772800000",
    "number": "1407399405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 328",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810520328",
            "telephone_number": "719-336-3244",
            "fax_number": "719-336-3898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S 4TH ST",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523804",
            "telephone_number": "719-336-3244",
            "fax_number": "719-336-3898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2016-11-22",
        "status": "A",
        "authorized_official_last_name": "ENGSBERG",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-336-3244"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04586719",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lamar, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.