MEDICARE: PLATTE VALLEY AMBULANCE SERVICE LLC

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	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1992243638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATTE VALLEY AMBULANCE SERVICE LLC

Provider Business Mailing Address
First Line	:	1750 E EGBERT ST
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-2326
Country	:	US
Telephone Number	:	720-385-8420
Fax Number	:	303-654-8166

Provider Business Practice Location Address
First Line	:	1750 E EGBERT ST
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-2326
Country	:	US
Telephone Number	:	720-385-8420
Fax Number	:	303-654-8166

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HAROLD T DUPPER
Credential	:
Telephone Number	:	303-498-1601

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	05/09/2017

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