Provider Demographics
NPI:1033263447
Name:CONVERSE COUNTY AMBULANCE
Entity Type:Organization
Organization Name:CONVERSE COUNTY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-358-2244
Mailing Address - Street 1:107 N 5TH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2423
Mailing Address - Country:US
Mailing Address - Phone:307-358-2244
Mailing Address - Fax:307-358-5998
Practice Address - Street 1:107 N 5TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2423
Practice Address - Country:US
Practice Address - Phone:307-358-2244
Practice Address - Fax:307-358-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW300018Medicare ID - Type UnspecifiedMEDICARE PART B