1609273416 NPI number — MOUNTAIN STATES EMERGENCY MEDICAL SERVICES LLC

Table of Contents

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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