Provider Demographics
NPI:1629608427
Name:SOUTHWEST TELLER COUNTY EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:SOUTHWEST TELLER COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-895-1206
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:CRIPPLE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80813-0826
Mailing Address - Country:US
Mailing Address - Phone:719-895-1206
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:700 NORTH A STREET
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813
Practice Address - Country:US
Practice Address - Phone:719-895-1206
Practice Address - Fax:270-744-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90000158052Medicaid