Provider Demographics
NPI:1306824891
Name:CONEJOS COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:CONEJOS COUNTY GOVERNMENT
Other - Org Name:CONEJOS COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:D
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-274-5084
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:CONEJOS
Mailing Address - State:CO
Mailing Address - Zip Code:81129-0215
Mailing Address - Country:US
Mailing Address - Phone:719-274-5804
Mailing Address - Fax:719-274-5850
Practice Address - Street 1:17705 US HIGHWAY 285 STE B
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-0244
Practice Address - Country:US
Practice Address - Phone:719-274-5804
Practice Address - Fax:719-274-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
707458200OtherDOL
CO06000194Medicaid