Basic Information
| Provider Information | |||||||||
| NPI: | 1689702615 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SILVERTON SAN JUAN COUNTY AMBULANCE ASSOCIATION INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707650818 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 GREENE STREET | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814330493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703875887 | ||||||||
| FaxNumber: | 9703875170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | GARDNER | ||||||||
| AuthorizedOfficialFirstName: | CHELSEA | ||||||||
| AuthorizedOfficialMiddleName: | CATHERINE | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9708195007 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 06000251 | 05 | CO | MEDICAID |