1144386111 NPI number — HEARTLAND PARAMEDICS-CSA 69 COUNTY SERVICE AREA 69 EMS

Table of content: (NPI 1144386111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144386111 NPI number — HEARTLAND PARAMEDICS-CSA 69 COUNTY SERVICE AREA 69 EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTLAND PARAMEDICS-CSA 69 COUNTY SERVICE AREA 69 EMS
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:
LAKESIDE-SANTEE AMBULANCE SERVICE
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:
1144386111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5510 OVERLAND AVE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-285-6429
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5510 OVERLAND AVE STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-6429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARR
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
DORMANN
Authorized Official Title or Position:
EMS ADMINNISTRATOR
Authorized Official Telephone Number:
858-245-4231

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MTE00993F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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