Provider Demographics
NPI:1568509818
Name:NORTHERN SAGUACHE COUNTY AMBULANCE
Entity Type:Organization
Organization Name:NORTHERN SAGUACHE COUNTY AMBULANCE
Other - Org Name:N.S.C.A.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-496-6528
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-8413
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:300 FOURTH ST
Practice Address - Street 2:
Practice Address - City:SAGUACHE
Practice Address - State:CO
Practice Address - Zip Code:81149-0724
Practice Address - Country:US
Practice Address - Phone:719-655-2206
Practice Address - Fax:719-323-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3143416L0300X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6637938Medicaid
CO06637938Medicaid
CO6637938Medicaid