1790854800 NPI number — AMBULANCE SERVICE OF RENO,INC DBA

Table of content: (NPI 1790854800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790854800 NPI number — AMBULANCE SERVICE OF RENO,INC DBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULANCE SERVICE OF RENO,INC DBA
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:
AME HOME HEALTH CARE
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:
1790854800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
395 S WELLS AVE
Provider Second Line Business Mailing Address:
PO BOX 2984
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-1611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-329-5567
Provider Business Mailing Address Fax Number:
775-329-8123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 S WELLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-329-5567
Provider Business Practice Location Address Fax Number:
775-329-8123
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GILLER
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
775-329-5567

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  MP00085 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3316005 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".