Provider Demographics
NPI:1295959328
Name:SOUTHERN COLORADO RURAL EMERGENCY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:SOUTHERN COLORADO RURAL EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-PARAMEDIC
Authorized Official - Phone:719-248-3978
Mailing Address - Street 1:7022 COUNTY RD. KK
Mailing Address - Street 2:
Mailing Address - City:MANZANOLA
Mailing Address - State:CO
Mailing Address - Zip Code:81058
Mailing Address - Country:US
Mailing Address - Phone:719-248-3978
Mailing Address - Fax:719-263-5683
Practice Address - Street 1:7022 COUNTY RD. KK
Practice Address - Street 2:
Practice Address - City:MANZANOLA
Practice Address - State:CO
Practice Address - Zip Code:81058-9705
Practice Address - Country:US
Practice Address - Phone:719-248-3978
Practice Address - Fax:719-263-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC486718Medicare ID - Type Unspecified