Provider Demographics
NPI:1477221604
Name:UTE PASS REGIONAL AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:UTE PASS REGIONAL AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIENST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-687-2291
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-0149
Mailing Address - Country:US
Mailing Address - Phone:719-687-2291
Mailing Address - Fax:
Practice Address - Street 1:785 RED FEATHER LN
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-1039
Practice Address - Country:US
Practice Address - Phone:719-687-2291
Practice Address - Fax:719-687-6410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTE PASS REGIONAL HEALTH SERVICE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06804781Medicaid