Provider Demographics
NPI:1477769057
Name:COPPER RIVER EMERGENCY MEDICAL SERVICES COUNCIL, INC.
Entity Type:Organization
Organization Name:COPPER RIVER EMERGENCY MEDICAL SERVICES COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT-1
Authorized Official - Phone:907-822-3671
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:MILE 187 GLENN HWY
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0529
Mailing Address - Country:US
Mailing Address - Phone:907-822-3671
Mailing Address - Fax:907-822-5170
Practice Address - Street 1:MILE 187 GLENN HWY
Practice Address - Street 2:BOX 529
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588-0529
Practice Address - Country:US
Practice Address - Phone:907-822-3671
Practice Address - Fax:907-822-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK03003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA6070Medicaid
AKGA6070Medicaid