Healthcare Provider Details

I. General information

NPI: 1679617781
Provider Name (Legal Business Name): IDALIA AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9141 RD CC.8
IDALIA CO
80735
US

IV. Provider business mailing address

PO BOX 55
IDALIA CO
80735-0055
US

V. Phone/Fax

Practice location:
  • Phone: 970-354-7285
  • Fax:
Mailing address:
  • Phone: 970-354-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA J. MOELLENBERG
Title or Position: DIRECTOR
Credential: EMT-I
Phone: 970-354-7285