Healthcare Provider Details

I. General information

NPI: 1275671356
Provider Name (Legal Business Name): TOWN OF PALISADE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 EAST 3RD STREET
PALISADE CO
81526
US

IV. Provider business mailing address

PO BOX 128
PALISADE CO
81526-0128
US

V. Phone/Fax

Practice location:
  • Phone: 970-464-5602
  • Fax:
Mailing address:
  • Phone: 800-300-9815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberPALISADE VFD
License Number StateCO

VIII. Authorized Official

Name: AMY PALMER
Title or Position: TREAS
Credential:
Phone: 970-464-5602