Provider Demographics
NPI:1760485684
Name:KIT CARSON COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:KIT CARSON COUNTY AMBULANCE SERVICE
Other - Org Name:KIT CARSON COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:KCC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-346-8133
Mailing Address - Street 1:1576 LOWELL AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807
Mailing Address - Country:US
Mailing Address - Phone:719-346-7878
Mailing Address - Fax:719-346-5118
Practice Address - Street 1:1576 LOWELL AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807
Practice Address - Country:US
Practice Address - Phone:719-346-7878
Practice Address - Fax:719-346-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO933416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06624639Medicaid
CO590010472OtherRAIL ROAD MEDICARE
KS100243030AMedicaid
CO590010472OtherPALMETTO GBA
CO590010472Medicare PIN
COC62463Medicare PIN