Provider Demographics
NPI:1407890734
Name:CITY OF FOUNTAIN
Entity Type:Organization
Organization Name:CITY OF FOUNTAIN
Other - Org Name:CITY OF FOUNTAIN EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-382-7800
Mailing Address - Street 1:116 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-2282
Mailing Address - Country:US
Mailing Address - Phone:719-382-7800
Mailing Address - Fax:719-382-1002
Practice Address - Street 1:212 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1931
Practice Address - Country:US
Practice Address - Phone:719-382-7800
Practice Address - Fax:719-382-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96372541Medicaid
CO=========Medicare UPIN
COC455958Medicare ID - Type Unspecified