1609273416 NPI number — MOUNTAIN STATES EMERGENCY MEDICAL SERVICES LLC

Table of content: (NPI 1609273416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609273416 NPI number — MOUNTAIN STATES EMERGENCY MEDICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN STATES EMERGENCY MEDICAL SERVICES LLC
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:
Provider Other Organization Name Type Code:
6
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:
1609273416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 W EULESS BLVD
Provider Second Line Business Mailing Address:
#600
Provider Business Mailing Address City Name:
EULESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-736-8950
Provider Business Mailing Address Fax Number:
720-307-3008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 S PARKER ROAD
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-565-2101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-565-2101

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 400069 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 42434301 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: BFN- 2015-BFN-000105 . This is a "BUSINESS LICENSE - DENVER, CO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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