Provider Demographics
NPI:1609986637
Name:CITY OF ENGLEWOOD
Entity Type:Organization
Organization Name:CITY OF ENGLEWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-762-2476
Mailing Address - Street 1:1000 ENGLEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2373
Mailing Address - Country:US
Mailing Address - Phone:303-336-3476
Mailing Address - Fax:303-479-7644
Practice Address - Street 1:3615 S ELATI ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-3519
Practice Address - Country:US
Practice Address - Phone:303-762-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06000129Medicaid
CO29631OtherBCBS
CO06000129Medicaid
CO59000847Medicare PIN
CO=========OtherTRICARE