1265469142 NPI number — RIGGS AMBULANCE SERVICE INC

Table of content: (NPI 1265469142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265469142 NPI number — RIGGS AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIGGS AMBULANCE SERVICE 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:
MERCED MEDICAL SUPPLY
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:
1265469142
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:
1827 CANAL STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95340-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-722-3832
Provider Business Mailing Address Fax Number:
209-722-2779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1827 CANAL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-722-3832
Provider Business Practice Location Address Fax Number:
209-722-2779
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BONIFAY
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
209-725-7000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  100030 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: ZZZ35992Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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