Healthcare Provider Details

I. General information

NPI: 1164759726
Provider Name (Legal Business Name): GILPIN AMBULANCE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 APEX RD
BLACK HAWK CO
80422
US

IV. Provider business mailing address

PO BOX 638
BLACK HAWK CO
80422-0638
US

V. Phone/Fax

Practice location:
  • Phone: 303-582-5499
  • Fax: 303-582-3390
Mailing address:
  • Phone: 303-582-5499
  • Fax: 303-582-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: BOBBY PUTNAM
Title or Position: CAPTAIN
Credential:
Phone: 303-582-5499