MEDICARE: SOUTHWEST ADAMS COUNTY FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	ADC00106	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033229893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ADAMS COUNTY FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	26 GARDEN CENTER 3C
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020
Country	:	US
Telephone Number	:	303-469-1133
Fax Number	:	303-469-4976

Provider Business Practice Location Address
First Line	:	3365 W 65TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221
Country	:	US
Telephone Number	:	303-429-3597
Fax Number	:	303-429-3598

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	GEORGE DITOLLA
Credential	:
Telephone Number	:	303-429-3597

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/05/2013

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