Healthcare Provider Details

I. General information

NPI: 1740213792
Provider Name (Legal Business Name): GILPIN AMBULANCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 GREGORY ST
BLACK HAWK CO
80422
US

IV. Provider business mailing address

PO BOX 755
BLACK HAWK CO
80422-0755
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 NumberCERTIFICATE
License Number StateCO

VIII. Authorized Official

Name: ZANE LAUBHAN
Title or Position: DIRECTOR
Credential:
Phone: 303-582-5499