Provider Demographics
NPI:1932298999
Name:TOWN OF LIMON
Entity Type:Organization
Organization Name:TOWN OF LIMON
Other - Org Name:LIMON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PARAMEDIC
Authorized Official - Phone:719-740-1149
Mailing Address - Street 1:110 A AVE
Mailing Address - Street 2:PO BOX 374
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828
Mailing Address - Country:US
Mailing Address - Phone:719-775-2256
Mailing Address - Fax:719-775-9291
Practice Address - Street 1:110 A AVE
Practice Address - Street 2:
Practice Address - City:LIMON
Practice Address - State:CO
Practice Address - Zip Code:80828
Practice Address - Country:US
Practice Address - Phone:719-775-2256
Practice Address - Fax:719-775-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104 - LINCOLN COUNTY341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06625636Medicaid
COC62563Medicare ID - Type Unspecified