Basic Information
| Provider Information | |||||||||
| NPI: | 1467880203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGURA | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 PINE ST | ||||||||
| Address2: | |||||||||
| City: | DEL NORTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811322243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196570616 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 560 PINE ST | ||||||||
| Address2: | |||||||||
| City: | DEL NORTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811322243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196570616 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2013 | ||||||||
| LastUpdateDate: | 10/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 146L00000X | CO | N | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | 146M00000X | CO | N | Emergency Medical Service Providers | Emergency Medical Technician, Intermediate | 146N00000X | CO | Y | Emergency Medical Service Providers | Emergency Medical Technician, Basic |
ID Information
| ID | Type | State | Issuer | Description | 1588652325 | 05 | CO | MEDICAID |