Provider Demographics
NPI:1609273416
Name:MOUNTAIN STATES EMERGENCY MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:MOUNTAIN STATES EMERGENCY MEDICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-565-2101
Mailing Address - Street 1:1316 W EULESS BLVD
Mailing Address - Street 2:#600
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040
Mailing Address - Country:US
Mailing Address - Phone:303-736-8950
Mailing Address - Fax:720-307-3008
Practice Address - Street 1:1230 S PARKER ROAD
Practice Address - Street 2:#100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:469-565-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO341600000X, 343900000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO400069OtherMEDICARE PTAN
CO42434301Medicaid
COBFN- 2015-BFN-000105OtherBUSINESS LICENSE - DENVER, CO