Healthcare Provider Details

I. General information

NPI: 1720462104
Provider Name (Legal Business Name): ALPINE EMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HIGHWAY 89
ALPINE WY
83128
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 307-654-7581
  • Fax:
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-991-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3
License Number StateWY

VIII. Authorized Official

Name: JEREMY LARSEN
Title or Position: EMS CHIEF
Credential:
Phone: 307-654-7581