Provider Demographics
NPI:1801879887
Name:NORTHGLENN AMBULANCE, INC.
Entity type:Organization
Organization Name:NORTHGLENN AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-451-6882
Mailing Address - Street 1:PO BOX 33498
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-0498
Mailing Address - Country:US
Mailing Address - Phone:303-451-6882
Mailing Address - Fax:303-255-9953
Practice Address - Street 1:10655 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-4101
Practice Address - Country:US
Practice Address - Phone:303-451-6882
Practice Address - Fax:303-255-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADCO06053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06633531Medicaid
COC63353Medicare ID - Type Unspecified