Provider Demographics
NPI:1942342951
Name:CLEAR CREEK COUNTY
Entity Type:Organization
Organization Name:CLEAR CREEK COUNTY
Other - Org Name:CLEAR CREEK AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-567-4221
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80444-2000
Mailing Address - Country:US
Mailing Address - Phone:303-567-4221
Mailing Address - Fax:303-567-4710
Practice Address - Street 1:3400 STANLEY ROAD
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:CO
Practice Address - Zip Code:80436-0407
Practice Address - Country:US
Practice Address - Phone:303-567-4221
Practice Address - Fax:303-567-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56222254Medicaid
COC61013Medicare ID - Type Unspecified