Provider Demographics
NPI:1578605309
Name:COUNTY OF CROWLEY
Entity Type:Organization
Organization Name:COUNTY OF CROWLEY
Other - Org Name:CROWLEY COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN BOARD OF COUNTY COMMISSION
Authorized Official - Prefix:MR
Authorized Official - First Name:T.E.(TOBE)
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLUMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-267-5555
Mailing Address - Street 1:603 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ORDWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81063-1042
Mailing Address - Country:US
Mailing Address - Phone:719-267-5555
Mailing Address - Fax:719-267-3114
Practice Address - Street 1:611 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1053
Practice Address - Country:US
Practice Address - Phone:719-267-5555
Practice Address - Fax:719-267-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2007-013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06612030Medicaid
CO06612030Medicaid
CO=========Medicare UPIN