Provider Demographics
NPI:1689770885
Name:MONTEZUMA COUNTY SENIOR TRANSP
Entity Type:Organization
Organization Name:MONTEZUMA COUNTY SENIOR TRANSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-4166
Mailing Address - Street 1:107 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3103
Mailing Address - Country:US
Mailing Address - Phone:970-565-4166
Mailing Address - Fax:970-565-0833
Practice Address - Street 1:107 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3103
Practice Address - Country:US
Practice Address - Phone:970-565-4166
Practice Address - Fax:970-565-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04141123Medicaid
COCOTP165972 AMedicaid