Provider Demographics
NPI:1790760361
Name:COUNTY OF GRAND
Entity Type:Organization
Organization Name:COUNTY OF GRAND
Other - Org Name:GRAND COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-725-3101
Mailing Address - Street 1:P.O. BOX 1457
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-1457
Mailing Address - Country:US
Mailing Address - Phone:970-887-2732
Mailing Address - Fax:970-887-1698
Practice Address - Street 1:81 W AGATE AVENUE
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446-1457
Practice Address - Country:US
Practice Address - Phone:970-887-2732
Practice Address - Fax:970-887-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00619837Medicaid
C61983Medicare PIN
CO00619837Medicaid