Provider Demographics
NPI:1356495337
Name:TOWN OF GUERNSEY
Entity Type:Organization
Organization Name:TOWN OF GUERNSEY
Other - Org Name:GUERNSEY VOL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZYNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-836-2335
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:GUERNSEY
Mailing Address - State:WY
Mailing Address - Zip Code:82214
Mailing Address - Country:US
Mailing Address - Phone:307-836-2335
Mailing Address - Fax:307-836-2601
Practice Address - Street 1:81 W WHALEN
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214
Practice Address - Country:US
Practice Address - Phone:307-836-2335
Practice Address - Fax:307-836-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113850200Medicaid
WYW307775Medicare UPIN
WYW307775Medicare ID - Type UnspecifiedMEDICARE PART B