Provider Demographics
NPI:1407069628
Name:LA JUNTA RURAL FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LA JUNTA RURAL FIRE PROTECTION DISTRICT
Other - Org Name:LA JUNTA RURAL AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:W
Authorized Official - Last Name:EVEATT
Authorized Official - Suffix:
Authorized Official - Credentials:EMTI
Authorized Official - Phone:719-384-2323
Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1066
Mailing Address - Country:US
Mailing Address - Phone:719-384-2323
Mailing Address - Fax:
Practice Address - Street 1:601 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2309
Practice Address - Country:US
Practice Address - Phone:719-384-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO291HXA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06624837Medicaid
COC62483Medicare ID - Type UnspecifiedPROVIDER NUMBER