Basic Information
| Provider Information | |||||||||
| NPI: | 1841270071 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF CHAFFEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 E. MAIN ST. | ||||||||
| Address2: | BUSINESS OPTIONS MEDICAL BILLING | ||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707650818 | ||||||||
| FaxNumber: | 9704978410 | ||||||||
| Practice Location | |||||||||
| Address1: | 10364 COUNTY ROAD 120 | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812019404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195391914 | ||||||||
| FaxNumber: | 9705398688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 03/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | HADLEY | ||||||||
| AuthorizedOfficialFirstName: | JOSH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EMS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7195391914 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 347E00000X | N | Transportation Services | Transportation Broker | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 06609135 | 05 | CO | MEDICAID | 590042777 | 01 | CO | RAILROAD MEDICARE | OTHER | 089233300 | 01 | CO | DEPT OF LABOR / FEDERAL WORKERS COMPENSATION | OTHER |