Kit Carson County Health Services District
Organization Active NPI Rural Health Clinic/Center · Burlington, CO
NPI 1932211596 · NPPES record last updated Feb 23, 2021
Key facts
- NPI
- 1932211596
- 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
- 182 16TH St
Burlington, CO 80807-1649 - Phone
- (719) 346-9481
- Fax
- (719) 346-9485
- NPI assigned
- Aug 31, 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
Practitioners 21
-
Krista Shalynn Davis, LCSW
-
Jesus Jaime Perez, M.D.
-
Sacramento Pimentel, M.D.
-
Amanda Folsom, PMHNP
-
Lani Michelle Magee, LCSW
-
Benjamin Gehret, C.R.N.A.
-
Lauren Elizabeth Gerk, DNP, CRNA
-
W Rafer Leach, M.D.
-
Paul Val Meredith, CRNA
-
Christopher C Moore, C-APN
-
Jacob Oppenheimer, M.D.
-
Jesse Enoch Smith, APRN
-
Josh Hill, CRNA
-
Samuel R Sims, CRNA
-
Udo G Foreman, PA-C
-
Gary D Kliewer, C.R.N.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO
Rural health clinic certification: CCN 063997
- Legal name
- KIT CARSON COUNTY HEALTH SERVICES DISTRICT
- Doing business as
- PARKE HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 25, 2000
- Last certification
- Nov 7, 2017
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Enrollment address
- 182 16TH St
Burlington, CO 80807-1649
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Brenda Briegel |
Corporate Director |
Apr 13, 2016 | |
| W-2 Managing Employee |
Jan 1, 2000 | ||
| Operational/Managerial Control |
Aug 1, 2012 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407001317 | CO | Part B Supplier - Clinic/Group Practice | 4385637917 |
Receives reassigned benefits from 20 practitioners Practice locations: Burlington, CO |
| O20080204000685 | CO | Part a Provider - Rural Health Clinic | 4385637917 | Practice locations: Burlington, CO |
National Provider Directory
Locations
182 16th St
Burlington, CO 80807
Phone (719) 346-4898
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 0905 | CO | Yes |
Addresses
Primary practice location
182 16TH St
Burlington, CO 80807-1649
Mailing address
182 16TH St
Burlington, CO 80807-1649
Phone (719) 346-9481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C248008 | Other | CO | MEDICARE PART B GROUP |
| 48557226 | Medicaid | CO |
Other names
- Parke Health Center
Other providers in Burlington, CO
- Kit Carson County Health and Human Services
- Kit Carson County Health Service District
- Kit Carson County Health Service District
- Kit Carson County Health Services District
- Kit Carson County Health Services District
- Kit Carson County Health Services District
- Vicky Jill Kosch
- Annjanette Lamar
- Conner Leiding
- Lifeline to Freedom, LLC
All providers in Burlington, 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.