Provider Demographics
NPI:1336339480
Name:CRITICAL CARE LIFE FLIGHT COLORADO
Entity Type:Organization
Organization Name:CRITICAL CARE LIFE FLIGHT COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-520-2617
Mailing Address - Street 1:59873 COUNTY ROAD 30
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:CO
Mailing Address - Zip Code:80721-9724
Mailing Address - Country:US
Mailing Address - Phone:970-520-2617
Mailing Address - Fax:
Practice Address - Street 1:59873 COUNTY ROAD 30
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:CO
Practice Address - Zip Code:80721-9724
Practice Address - Country:US
Practice Address - Phone:970-520-2617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87821354Medicaid
COC804093Medicare PIN