Healthcare Provider Details

I. General information

NPI: 1780727065
Provider Name (Legal Business Name): UPPER SAN JUAN HEALTH SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date: 12/20/2011
Reactivation Date: 03/08/2012

III. Provider practice location address

189 N PAGOSA BLVD
PAGOSA SPRINGS CO
81147
US

IV. Provider business mailing address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

V. Phone/Fax

Practice location:
  • Phone: 970-731-3700
  • Fax: 970-731-3707
Mailing address:
  • Phone: 970-731-3700
  • Fax: 970-731-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: RHONDA WEBB
Title or Position: CEO, CMO
Credential: MD
Phone: 970-731-3700