Provider Demographics
NPI:1548376106
Name:MONTEZUMA COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity type:Organization
Organization Name:MONTEZUMA COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LUE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-3769
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:ROOM 203
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3126
Mailing Address - Country:US
Mailing Address - Phone:970-565-3769
Mailing Address - Fax:970-565-8526
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:ROOM 203
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3126
Practice Address - Country:US
Practice Address - Phone:970-565-3769
Practice Address - Fax:970-565-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416A0800XTransportation ServicesAmbulanceAir Transport
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered344600000XTransportation ServicesTaxi
Not Answered347B00000XTransportation ServicesBus
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Not Answered347D00000XTransportation ServicesTrain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21472Medicaid
CO06200422Medicaid