Organization
SOUTH FORK AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERI BRYD (OFFICE MANAGER)
(719) 852-2362
Entity
Organization
Contact information
Practice address
28 MALL STREET, SOUTH FORK, CO 81154
(800) 473-2278
Mailing address
PO BOX 207, ALLENTOWN, PA 18105-0207
(484) 664-2007
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06000749
—
CO
01
—
826590682
RR MEDICARE
CO
01
—
840765177
TRICARE
CO
01
—
S063893
BS
CO
Enumeration date
03/20/2007
Last updated
05/17/2011
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