Provider Demographics
NPI:1588607105
Name:COMMUNITY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:COMMUNITY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAGERLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-765-4571
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:427 RUFFNER AVE.
Mailing Address - City:FLAGLER
Mailing Address - State:CO
Mailing Address - Zip Code:80815
Mailing Address - Country:US
Mailing Address - Phone:719-765-4571
Mailing Address - Fax:303-617-0135
Practice Address - Street 1:427 RUFFNER AVE.
Practice Address - Street 2:
Practice Address - City:FLAGLER
Practice Address - State:CO
Practice Address - Zip Code:80815
Practice Address - Country:US
Practice Address - Phone:719-765-4571
Practice Address - Fax:303-617-0135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY AMBULANCE SERVICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO198711978793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06611131Medicaid
CO06611131Medicaid
COC61113Medicare PIN