Provider Demographics
NPI:1962506519
Name:CITY OF LITTLETON
Entity type:Organization
Organization Name:CITY OF LITTLETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIVISION CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-734-8309
Mailing Address - Street 1:PO BOX 911885
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1885
Mailing Address - Country:US
Mailing Address - Phone:303-795-3864
Mailing Address - Fax:
Practice Address - Street 1:2255 W BERRY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80165
Practice Address - Country:US
Practice Address - Phone:303-795-3864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34555552Medicaid
590014609OtherRAILROAD
CO=========OtherTRICARE
CO34555552Medicaid
CO590014609Medicare PIN