Provider Demographics
NPI:1285632539
Name:EAGLE COUNTY HEALTH SERVICE DISTRICT
Entity Type:Organization
Organization Name:EAGLE COUNTY HEALTH SERVICE DISTRICT
Other - Org Name:EAGLE COUNTY AMBULANCE DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MNAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-926-5270
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-0990
Mailing Address - Country:US
Mailing Address - Phone:970-926-5270
Mailing Address - Fax:970-436-4105
Practice Address - Street 1:1055 EDWARDS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8196
Practice Address - Country:US
Practice Address - Phone:970-926-5270
Practice Address - Fax:970-436-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON/A341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06608939Medicaid
COC60893Medicare ID - Type UnspecifiedCOLORADO MEDICARE