Provider Demographics
NPI:1245238955
Name:WEST CUSTER COUNTY HOSPITAL DIST
Entity Type:Organization
Organization Name:WEST CUSTER COUNTY HOSPITAL DIST
Other - Org Name:CUSTER COUNTY AMBULANCE CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-693-0251
Mailing Address - Street 1:704 EDWARDS
Mailing Address - Street 2:
Mailing Address - City:WESTCLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:81252
Mailing Address - Country:US
Mailing Address - Phone:719-783-2380
Mailing Address - Fax:719-783-2377
Practice Address - Street 1:701 EDWARDS AVENUE
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-8588
Practice Address - Country:US
Practice Address - Phone:719-783-4447
Practice Address - Fax:719-783-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06612238Medicaid
CO=========OtherROCKY MOUNTAIN HEALTH PLA