Provider Demographics
NPI:1730294158
Name:MINERAL COUNTY
Entity Type:Organization
Organization Name:MINERAL COUNTY
Other - Org Name:MINERAL COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-776-1017
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:CREEDE
Mailing Address - State:CO
Mailing Address - Zip Code:81130-0224
Mailing Address - Country:US
Mailing Address - Phone:719-223-9033
Mailing Address - Fax:719-223-9033
Practice Address - Street 1:800 RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:CREEDE
Practice Address - State:CO
Practice Address - Zip Code:81130-5000
Practice Address - Country:US
Practice Address - Phone:719-223-9033
Practice Address - Fax:719-223-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO590015075OtherRAILROAD MEDICARE
CO36580872Medicaid
COC62963Medicare ID - Type Unspecified
CO590015075OtherRAILROAD MEDICARE