MEDICARE: DOVE CREEK VOLUNTEER AMBULANCE SERVICE INC.

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	3416L0300X	Land Ambulance

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	:	1144362203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOVE CREEK VOLUNTEER AMBULANCE SERVICE INC.

Provider Business Mailing Address
First Line	:	PO BOX 641880
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-7880
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-991-0719

Provider Business Practice Location Address
First Line	:	222 N. GUYRENE
Second Line	:
City	:	DOVE CREEK
State	:	CO
Zip	:	81324-6300
Country	:	US
Telephone Number	:	970-677-2257
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANGELA L MYERS
Credential	:
Telephone Number	:	970-739-3561

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	05/20/2015

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