Healthcare Provider Details

I. General information

NPI: 1750616447
Provider Name (Legal Business Name): PUEBLO WEST METROPOLITAN DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E HAHNS PEAK AVE
PUEBLO WEST CO
81007-2660
US

IV. Provider business mailing address

PO BOX 7005
PUEBLO WEST CO
81007-0005
US

V. Phone/Fax

Practice location:
  • Phone: 719-547-7337
  • Fax: 719-547-1769
Mailing address:
  • Phone: 719-547-7337
  • Fax: 719-547-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS-5
License Number StateCO

VIII. Authorized Official

Name: BRIAN CASERTA
Title or Position: FIRE CHIEF
Credential:
Phone: 719-547-7337