Provider Demographics
NPI:1720202856
Name:TRINIDAD AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:TRINIDAD AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:EMS CHIEF
Authorized Official - Phone:719-846-6886
Mailing Address - Street 1:939 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2832
Mailing Address - Country:US
Mailing Address - Phone:719-846-6886
Mailing Address - Fax:719-846-8431
Practice Address - Street 1:939 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2832
Practice Address - Country:US
Practice Address - Phone:719-846-6886
Practice Address - Fax:719-846-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2205264OtherAETNA
CO06000327Medicaid
CO2205264OtherAETNA
590005611Medicare PIN