Provider Demographics
NPI:1942341482
Name:SOUTH Y-W AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:SOUTH Y-W AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:IDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-362-4561
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:KIRK
Mailing Address - State:CO
Mailing Address - Zip Code:80824-0051
Mailing Address - Country:US
Mailing Address - Phone:970-362-4561
Mailing Address - Fax:970-362-4397
Practice Address - Street 1:3262 COUNTY RD M
Practice Address - Street 2:
Practice Address - City:KIRK
Practice Address - State:CO
Practice Address - Zip Code:80824-0051
Practice Address - Country:US
Practice Address - Phone:970-362-4561
Practice Address - Fax:970-362-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06600639Medicaid
CO60063Medicare PIN