NPIMap

Organization Active NPI

East Phillips County Hospital District

Doing business as MMH Hometown pharmacy

  • Community/Retail Pharmacy
  • Holyoke, CO
National Provider Identifier
1861940439
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PDO.1680000118 Issued in CO
Legal business name
EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Doing business as
MMH Hometown pharmacy
Practice address
1001 E Johnson St
Holyoke, CO 80734-1854
Phone
(970) 854-2222
Fax
(970) 854-2221
NPI assigned
Sep 13, 2016
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Authorized official

Name
Michael Hassell
Title
Ceo
Phone
(970) 854-2241

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PDO.1680000118 CO Primary
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

1001 E Johnson St
Holyoke, CO 80734-1854

Mailing address

1001 E Johnson St
Holyoke, CO 80734-1854
Phone (970) 854-2222

Other identifiers 1

IdentifierTypeStateIssuer
2164123OtherPK

Other names 1

  • MMH Hometown pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161219000543 CO Part B Supplier - Mass Immunization (Roster Biller Only) 9638161615 Practice locations: Holyoke, CO
O20161219002738 CO Part B Supplier - Pharmacy 9638161615 Practice locations: Holyoke, CO

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
East Phillips County Hospital District9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Melissa Memorial HospitalHolyoke, CO, CCN 061305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 11, 1966
Melissa Memorial HospitalHolyoke, CO, CCN 06Z305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 11, 1966
Family Practice of HolyokeHolyoke, CO, CCN 063400 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1861940439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E JOHNSON ST",
            "city": "HOLYOKE",
            "state": "CO",
            "postal_code": "807341854",
            "telephone_number": "970-854-2222",
            "fax_number": "970-854-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E JOHNSON ST",
            "city": "HOLYOKE",
            "state": "CO",
            "postal_code": "807341854",
            "telephone_number": "970-854-2222",
            "fax_number": "970-854-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST PHILLIPS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-13",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "HASSELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-854-2241"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "PDO.1680000118",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164123",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMH Hometown pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MMH Hometown pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holyoke, CO

Sources for this page

Verify at the official NPI Registry.