Provider Demographics
NPI:1669639571
Name:PLATTE CANYON RESCUE SERVICE INC
Entity Type:Organization
Organization Name:PLATTE CANYON RESCUE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-798-6347
Mailing Address - Street 1:PO BOX 3982
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80161-3982
Mailing Address - Country:US
Mailing Address - Phone:303-798-6347
Mailing Address - Fax:303-798-5299
Practice Address - Street 1:153 DELWOOD DR
Practice Address - Street 2:UNIT 2
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421
Practice Address - Country:US
Practice Address - Phone:303-838-8809
Practice Address - Fax:303-838-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO198712493713416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06634836Medicaid
CO06634836Medicaid