Salud Family Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Trinidad, CO
NPI 1497393003 · NPPES record last updated Jan 25, 2023
Key facts
- NPI
- 1497393003
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SALUD FAMILY HEALTH
- Practice address
- 928 Smith Ave
Trinidad, CO 81082-2841 - Phone
- (303) 697-2583
- NPI assigned
- Dec 13, 2019
- Organization subpart
- No
Authorized official
- Name
- David Madsen
- Title
- Cfo
- Phone
- (720) 322-9405
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 14
Corporate family (same tax ID) 17
Practitioners 79
-
Michael O Beer, PA
-
Lisa Bolander, LCSW
-
Jeremy Cade Christensen, D.P.M.
-
Ann E Dominguez, MD
-
Karen I Fedde, MD
-
Alison Marie Godinez, PA-C
-
Timothy J Nagel, MD
-
Daniel H Norton, PA
-
John Oberlies, PA-C
-
Sonia Pankonin, PA
-
Tattiana Romo, PH.D
-
Anthony D Rork, MPAS
-
Michael W Allen, DO
-
Joshua F. Bailey, M.D.
-
Matthew S Brett, MD
-
Lauren Brink, PA
-
Laura E Clark, PA-C
-
Ysell D Cordoba, LPC
-
Caitlyn Murphy Davis, PA-C
-
Pradeep Dhar, MD
-
Pedro Felix Diaz Ramos, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO
Federally qualified health center certification: CCN 061009
- Legal name
- SALUD FAMILY HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 27, 2020
- Last certification
- Jan 27, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 21, 1971 in CO
- Enrollment address
- 928 Smith Ave
Trinidad, CO 81082-2841
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Colleen L Laeger |
Corporate Officer |
Jan 1, 1978 | |
| Jesus a Tijerina |
Corporate Officer |
Jan 7, 1970 | |
| David Madsen |
Corporate Officer |
Aug 24, 2016 | |
| Operational/Managerial Control | Aug 24, 2016 | ||
| John Santistevan |
Corporate Director |
Sep 27, 1996 | |
| Joseph Daniel O'Connor |
Corporate Officer | Apr 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031126000756 | CO | Part B Supplier - Clinic/Group Practice | 3173433398 |
Receives reassigned benefits from 93 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fort Morgan, CO; Frederick, CO; Longmont, CO; Sterling, CO; Trinidad, CO; Aurora, CO; Brighton, CO; Commerce City, CO… |
| O20200127000591 | CO | Part a Provider - Federally Qualified Health Center (FQHC) | 3173433398 | Practice locations: Trinidad, CO |
National Provider Directory
- Tax ID family
- Salud Family Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
928 Smith Ave
Trinidad, CO 81082-2841
Mailing address
203 S Rollie Ave
Fort Lupton, CO 80621-1508
Phone (303) 892-6401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000181480 | Medicaid | CO |
Other names
- Plan De Salud Del Valle, Inc
Other providers in Trinidad, CO
- Reliant Renal Care-Colorado, LLC
- Rocky Mountain Eye Center, Inc. a Colorado Provider Network
- William Mervin Rowland Jr.
- Safeway Inc
- Sally L. Fabec, M. D.
- Salud Family Health
- San Luis Valley Eye Care LLC
- Dario Byung San Roman
- Kayla Brittany Sanchez
- Eric Steven Sandoval Sr.
All providers in Trinidad, CO · Federally Qualified Health Center (FQHC) in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2023. 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.