Provider Demographics
NPI:1700074705
Name:MAYBELL VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:MAYBELL VOLUNTEER AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-298-4747
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:MAYBELL
Mailing Address - State:CO
Mailing Address - Zip Code:81640-0084
Mailing Address - Country:US
Mailing Address - Phone:801-298-4747
Mailing Address - Fax:
Practice Address - Street 1:114 COLLUM
Practice Address - Street 2:
Practice Address - City:MAYBELL
Practice Address - State:CO
Practice Address - Zip Code:81640
Practice Address - Country:US
Practice Address - Phone:970-272-3209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2006-563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport