1255424800 NPI number — EASTERN PARAMEDICS INC

Table of content: (NPI 1255424800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255424800 NPI number — EASTERN PARAMEDICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN PARAMEDICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255424800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-913-9106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 RICHMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13204-2288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-471-0102
Provider Business Practice Location Address Fax Number:
315-471-3944
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP OF REVENUE MANAGEMENT
Authorized Official Telephone Number:
833-703-2294

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 31834 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015173400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040401001148 . This is a "FIDELAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01469438 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255424800 . This is a "TRICARE EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 623 . This is a "TOTAL CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4462038 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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