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General NPI Number Information
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NPI Number | 1306097282
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Entity Type | Organization
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Legal Business Name | MAYBELL VOLUNTEER AMBULANCE
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 314 COLLAM STREET
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City | MAYBELL
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State | CO
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Zip | 81640
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Country | US
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Telephone | 970-824-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 221 WEST VICTORY WAY STE 110
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City | CRAIG
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State | CO
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Zip | 81625
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Country | US
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Telephone | 970-272-3209
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MARSHA BLACK
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Credential | CPC
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Telephone | 801-295-9886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 200656
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License Number State | CO
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