Basic Information
| Provider Information | |||||||||
| NPI: | 1134248297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TELLURIDE FIRE PROTECTION DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1645 | ||||||||
| Address2: | |||||||||
| City: | TELLURIDE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814351645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707283801 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 W COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | TELLURIDE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707283801 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | WHITFIELD | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OPERATION FIELD MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9707283801 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | CO | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 06000673 | 05 | CO | MEDICAID |