Provider Demographics
NPI:1740213792
Name:GILPIN AMBULANCE INC.
Entity Type:Organization
Organization Name:GILPIN AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUBHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-582-5499
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-0755
Mailing Address - Country:US
Mailing Address - Phone:303-582-5499
Mailing Address - Fax:303-582-3390
Practice Address - Street 1:416 GREGORY ST
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:CO
Practice Address - Zip Code:80422
Practice Address - Country:US
Practice Address - Phone:303-582-5499
Practice Address - Fax:303-582-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCERTIFICATE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC61933Medicare UPIN
COC61933Medicare ID - Type Unspecified