1497800668 NPI number — SOUTHWEST TELLER COUNTY EMERGENCY MEDICAL SERVICES

Table of content: (NPI 1497800668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497800668 NPI number — SOUTHWEST TELLER COUNTY EMERGENCY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST TELLER COUNTY EMERGENCY MEDICAL SERVICES
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:
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:
1497800668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 826
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRIPPLE CREEK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80813-0826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-895-1206
Provider Business Mailing Address Fax Number:
270-744-8642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 NORTH A STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRIPPLE CREEK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80813-5026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-895-1206
Provider Business Practice Location Address Fax Number:
719-505-7360
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
719-895-1206

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 76926770 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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