Provider Demographics
NPI:1164562435
Name:PARADOX VALLEY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:PARADOX VALLEY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-428-4000
Mailing Address - Street 1:21389 6.00 ROAD
Mailing Address - Street 2:PO BOX 393
Mailing Address - City:PARADOX
Mailing Address - State:CO
Mailing Address - Zip Code:81429
Mailing Address - Country:US
Mailing Address - Phone:970-859-7330
Mailing Address - Fax:
Practice Address - Street 1:21389 6.00 ROAD
Practice Address - Street 2:
Practice Address - City:PARADOX
Practice Address - State:CO
Practice Address - Zip Code:81429
Practice Address - Country:US
Practice Address - Phone:970-859-7330
Practice Address - Fax:970-859-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000000146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty