Organization
PROWERS COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN GLOVER (OPERATIONS DIRECTOR)
(719) 336-8039
Entity
Organization
Contact information
Practice address
407 E OLIVE ST, LAMAR, CO 81052-2842
(719) 336-8039
Mailing address
407 E OLIVE ST, LAMAR, CO 81052-2842
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
06001481
CO
343900000X
Non-emergency Medical Transport (VAN)
Primary
25102567
CO
343900000X
Non-emergency Medical Transport (VAN)
91875714
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06001481
—
CO
05
—
25102567
—
CO
05
—
91875714
—
CO
Enumeration date
09/20/2012
Last updated
09/20/2012
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