=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245698513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCKY MTN EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2016
-----------------------------------------------------
Last Update Date | 02/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5100 SAN FRANCISCO RD NE SUITE A
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-328-6269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 SAN FRANCISCO RD NE SUITE A
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-328-6269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | EDWARD S. LITTLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-328-6269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 5133742
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------