Provider Demographics
NPI:1255452587
Name:FOUR MILE EMERGENCY SERVICES, INC.
Entity type:Organization
Organization Name:FOUR MILE EMERGENCY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUANNE
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-689-6136
Mailing Address - Street 1:8437 TELLER CO. RD. 11
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-8609
Mailing Address - Country:US
Mailing Address - Phone:719-689-2745
Mailing Address - Fax:719-689-3451
Practice Address - Street 1:8437 TELLER CO. RD. 11
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-8609
Practice Address - Country:US
Practice Address - Phone:719-689-2745
Practice Address - Fax:719-689-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98-09637-000146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06060370Medicaid
CO06060370Medicaid