Provider Demographics
NPI:1275692782
Name:LAS ANIMAS BENT COUNTY FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LAS ANIMAS BENT COUNTY FIRE PROTECTION DISTRICT
Other - Org Name:BENT COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-456-1825
Mailing Address - Street 1:P.O. BOX 2
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-1527
Mailing Address - Country:US
Mailing Address - Phone:719-456-1915
Mailing Address - Fax:719-456-0301
Practice Address - Street 1:52 N. BENT AVENUE
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1527
Practice Address - Country:US
Practice Address - Phone:719-456-1915
Practice Address - Fax:719-456-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0505967553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06605133Medicaid
COP00197942OtherRAILROAD MEDICARE ID
COP00197942OtherRAILROAD MEDICARE ID