Provider Demographics
NPI:1902056864
Name:NORTHWEST FREMONT EMS, INC.
Entity Type:Organization
Organization Name:NORTHWEST FREMONT EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HECOX
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:719-275-3450
Mailing Address - Street 1:110 SOUTH BND
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9772
Mailing Address - Country:US
Mailing Address - Phone:719-275-3450
Mailing Address - Fax:719-275-4350
Practice Address - Street 1:110 SOUTH BND
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9772
Practice Address - Country:US
Practice Address - Phone:719-275-3450
Practice Address - Fax:719-275-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03228550Medicaid
CO03228550Medicaid