NPIMap

Organization Active NPI

West Custer County Hospital Dist

Doing business as Custer County Ambulance Corp

  • Ambulance
  • Westcliffe, CO
National Provider Identifier
1245238955
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
Legal business name
WEST CUSTER COUNTY HOSPITAL DIST
Doing business as
Custer County Ambulance Corp
Practice address
701 Edwards Avenue
Westcliffe, CO 81252-8588
Phone
(719) 783-4447
Fax
(719) 783-2086
NPI assigned
Jul 7, 2005
Last updated
May 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tyler Harkins
Title
EMS Manager
Phone
(615) 693-0251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X Primary

Addresses

Primary practice location

701 Edwards Avenue
Westcliffe, CO 81252-8588

Mailing address

704 Edwards
Westcliffe, CO 81252
Phone (719) 783-2380

Other identifiers 2

IdentifierTypeStateIssuer
=========OtherCOROCKY MOUNTAIN HEALTH PLA
06612238MedicaidCO

Other names 1

  • Custer County Ambulance Corp Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090513000409 CO Part B Supplier - Ambulance Service Supplier 1759293723 Practice locations: Westcliffe, CO

National Provider Directory

National Provider Directory
Tax ID family
W Custer County Hosp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

701 Edwards Ave
Westcliffe, CO 81252
Phone (719) 783-2380

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1245238955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 EDWARDS",
            "city": "WESTCLIFFE",
            "state": "CO",
            "postal_code": "81252",
            "telephone_number": "719-783-2380",
            "fax_number": "719-783-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 EDWARDS AVENUE",
            "city": "WESTCLIFFE",
            "state": "CO",
            "postal_code": "812528588",
            "telephone_number": "719-783-4447",
            "fax_number": "719-783-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST CUSTER COUNTY HOSPITAL DIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2022-05-13",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "HARKINS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "EMS MANAGER",
        "authorized_official_telephone_number": "615-693-0251"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROCKY MOUNTAIN HEALTH PLA",
            "identifier": "=========",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06612238",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custer County Ambulance Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custer County Ambulance Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westcliffe, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.