Provider Demographics
NPI:1881694313
Name:WASHINGTON COUNTY COLORADO
Entity type:Organization
Organization Name:WASHINGTON COUNTY COLORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:EMP
Authorized Official - Phone:970-345-2672
Mailing Address - Street 1:133 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:CO
Mailing Address - Zip Code:80720-1513
Mailing Address - Country:US
Mailing Address - Phone:970-345-2672
Mailing Address - Fax:970-345-2702
Practice Address - Street 1:133 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:CO
Practice Address - Zip Code:80720-1513
Practice Address - Country:US
Practice Address - Phone:970-345-2672
Practice Address - Fax:970-345-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06646434Medicaid
CO64643Medicare ID - Type UnspecifiedMEDICARE ID NUMBER