Organization
SOUTH PARK AMBULANCE DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISSA MATTSON (CHIEF ADMINISTRATIVE OFFICER)
(719) 836-2055
Entity
Organization
Contact information
Practice address
911 CASTELLO AVENUE, FAIRPLAY, CO 80440
(719) 836-2055
Mailing address
911 CASTELLO AVENUE, FAIRPLAY, CO 80440
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06000442
—
CO
Enumeration date
09/08/2006
Last updated
08/22/2020
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