Provider Demographics
NPI:1477183408
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:270-744-8642
Practice Address - Street 1:17705 STATE HWY 285
Practice Address - Street 2:SUITE B
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140
Practice Address - Country:US
Practice Address - Phone:719-274-5804
Practice Address - Fax:270-744-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000157470Medicaid