MEDICARE: COLORADO COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	45001	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590900120	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	504021	OTHER	TX	BC/BS OF TEXAS

General Provider Information

NPI Number	:	1295759942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO COUNTY

Provider Business Mailing Address
First Line	:	305 RADIO LN
Second Line	:	ROOM 101
City	:	COLUMBUS
State	:	TX
Zip	:	78934-3235
Country	:	US
Telephone Number	:	979-732-2188
Fax Number	:	979-732-9635

Provider Business Practice Location Address
First Line	:	305 RADIO LN
Second Line	:	ROOM 101
City	:	COLUMBUS
State	:	TX
Zip	:	78934-3235
Country	:	US
Telephone Number	:	979-732-2188
Fax Number	:	979-732-9635

Authorized Official
Title or Position	:	EMS ADMINISTRATOR
Name	:	PATTY NELSON
Credential	:
Telephone Number	:	979-732-2188

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/05/2014

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Directions to “COLORADO COUNTY ” Practice Location

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