=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245104967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP MICHAEL MAASS MED TECH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2025
-----------------------------------------------------
Last Update Date | 10/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 MEADOWOOD DR
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81623-9212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-900-6833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 485 PINON PT
-----------------------------------------------------
City | GLENWOOD SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81601-9697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-309-5770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146N00000X
-----------------------------------------------------
Taxonomy Name | Basic Emergency Medical Technician
-----------------------------------------------------
License Number | 057378
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------