Provider Demographics
NPI:1831812320
Name:KIT CARSON COUNTY HEALTH SERVICE DISTRICT
Entity type:Organization
Organization Name:KIT CARSON COUNTY HEALTH SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-346-5311
Mailing Address - Street 1:286 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807
Mailing Address - Country:US
Mailing Address - Phone:719-346-5311
Mailing Address - Fax:719-931-1256
Practice Address - Street 1:286 16TH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807
Practice Address - Country:US
Practice Address - Phone:719-346-5311
Practice Address - Fax:719-931-1256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIT CARSON COUNTY HEALTH SERVICE DIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78774080Medicaid