1124030739 NPI number — ADVANCED MEDICAL AMBULANCE CORP

Table of content: (NPI 1124030739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124030739 NPI number — ADVANCED MEDICAL AMBULANCE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL AMBULANCE CORP
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:
Provider Other Organization Name Type Code:
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:
1124030739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/08/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2545
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN GERMAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00683-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-264-5564
Provider Business Mailing Address Fax Number:
787-264-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST 3362 KM 0.4
Provider Second Line Business Practice Location Address:
WARD GUAMA
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-264-5564
Provider Business Practice Location Address Fax Number:
787-264-0703
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALBINO
Authorized Official First Name:
IRIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-264-5564

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TCAMB-388 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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