Provider Demographics
NPI:1174712871
Name:CITY OF WRAY
Entity type:Organization
Organization Name:CITY OF WRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NREMT-P
Authorized Official - Phone:970-332-4086
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:245 W. 4TH ST.
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-0035
Mailing Address - Country:US
Mailing Address - Phone:970-332-4086
Mailing Address - Fax:970-332-4084
Practice Address - Street 1:245 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-1703
Practice Address - Country:US
Practice Address - Phone:970-332-4086
Practice Address - Fax:970-332-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06609333Medicaid
COC60933Medicare PIN