Provider Demographics
NPI:1609829118
Name:COLUMBINE EMERGENCY MEDICAL SERVICE, INC
Entity Type:Organization
Organization Name:COLUMBINE EMERGENCY MEDICAL SERVICE, INC
Other - Org Name:COLUMBINE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-794-1911
Mailing Address - Street 1:5893 SOUTH PRINCE STREET
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120
Mailing Address - Country:US
Mailing Address - Phone:303-794-1911
Mailing Address - Fax:303-798-3670
Practice Address - Street 1:5893 SOUTH PRINCE STREET
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:303-794-1911
Practice Address - Fax:303-798-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06611032Medicaid
CO06611032Medicaid