1275692782 NPI number — LAS ANIMAS BENT COUNTY FIRE PROTECTION DISTRICT

Table of content: (NPI 1275692782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275692782 NPI number — LAS ANIMAS BENT COUNTY FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS ANIMAS BENT COUNTY FIRE PROTECTION DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BENT COUNTY AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275692782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS ANIMAS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81054-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-456-1915
Provider Business Mailing Address Fax Number:
719-456-0301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 N. BENT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS ANIMAS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81054-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-456-1915
Provider Business Practice Location Address Fax Number:
719-456-0301
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEAL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
719-456-1825

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  050596755 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06605133 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00197942 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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