=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457594053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENROSE VOLUNTEER FIRE DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2009
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2233 EAST MAIN STREET
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-249-3700
-----------------------------------------------------
Fax | 970-497-8410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 BROADWAY
-----------------------------------------------------
City | PENROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-372-3001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULANCE DIRECTOR
-----------------------------------------------------
Name | CALVIN SUNDERMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-372-3001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------