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General NPI Number Information
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NPI Number | 1033263447
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Entity Type | Organization
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Legal Business Name | CONVERSE COUNTY AMBULANCE
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 N 5TH ST SUITE 114
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City | DOUGLAS
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State | WY
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Zip | 82633-2423
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Country | US
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Telephone | 307-358-2244
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Fax | 307-358-5998
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Provider Business Mailing Address
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Address Line | 107 N 5TH ST SUITE 114
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City | DOUGLAS
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State | WY
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Zip | 82633-2423
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Country | US
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Telephone | 307-358-2244
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Fax | 307-358-5998
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Authorized Official
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Title or Position | BILLING CLERK
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Name | ANDREA L JOHNSON
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Credential |
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Telephone | 307-358-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | WY
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