Provider Demographics
NPI:1609942549
Name:COOPER LANDING EMERGENCY SERVICES, INC.
Entity Type:Organization
Organization Name:COOPER LANDING EMERGENCY SERVICES, INC.
Other - Org Name:COOPER LANDING VOLUNTEER AMBULANCE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-595-1800
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:COOPER LANDING
Mailing Address - State:AK
Mailing Address - Zip Code:99572-0510
Mailing Address - Country:US
Mailing Address - Phone:907-595-1800
Mailing Address - Fax:907-595-1800
Practice Address - Street 1:38748 A SNUG HARBOR ROAD
Practice Address - Street 2:
Practice Address - City:COOPER LANDING
Practice Address - State:AK
Practice Address - Zip Code:99572-0776
Practice Address - Country:US
Practice Address - Phone:907-595-1800
Practice Address - Fax:907-595-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK712498146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGA0310Medicaid
AKGA0310Medicaid