NPIMap

Organization Active NPI

Dolores County Health Association

  • Federally Qualified Health Center (FQHC)
  • Dove Creek, CO
National Provider Identifier
1710954433
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0589 Issued in CO
Legal business name
DOLORES COUNTY HEALTH ASSOCIATION
Practice address
495 W 4TH St
Dove Creek, CO 81324-0576
Phone
(970) 677-2291
Fax
(970) 677-2540
NPI assigned
Mar 1, 2006
Last updated
May 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

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

Authorized official

Name
Mrs. Dianne Smith
Title
Executive Director
Phone
(970) 677-2291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0589 CO Primary

Addresses

Primary practice location

495 W 4TH St
Dove Creek, CO 81324-0576

Mailing address

PO Box 576
Dove Creek, CO 81324-0576
Phone (970) 677-2291

Other identifiers 1

IdentifierTypeStateIssuer
05682000MedicaidCO

Other names 1

  • Community Health Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710954433. Details of each certification follow.

  • CCN 061804 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 061804

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1992
Last certification
Jun 1, 1992
Ownership / control type
For profit – corporation
Facility address
495 W 4TH Street
Dove Creek, CO 81324

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338336000000",
    "number": "1710954433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 576",
            "city": "DOVE CREEK",
            "state": "CO",
            "postal_code": "813240576",
            "telephone_number": "970-677-2291",
            "fax_number": "970-677-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 W 4TH ST",
            "city": "DOVE CREEK",
            "state": "CO",
            "postal_code": "813240576",
            "telephone_number": "970-677-2291",
            "fax_number": "970-677-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOLORES COUNTY HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2012-05-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DIANNE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-677-2291",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "0589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05682000",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dove Creek, CO

Sources for this page

Verify at the official NPI Registry.