1487734349 NPI number — PRIORITY ONE MEDICAL TRANSPORT, INC.

Table of content: (NPI 1487734349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487734349 NPI number — PRIORITY ONE MEDICAL TRANSPORT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY ONE MEDICAL TRANSPORT, 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:
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:
1487734349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9327 FAIRWAY VIEW PL
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-0968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-600-3350
Provider Business Mailing Address Fax Number:
909-948-4492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9327 FAIRWAY VIEW PL
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-0968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-600-3350
Provider Business Practice Location Address Fax Number:
909-948-4492
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
SUZANNE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-600-3350

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  A136 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CGP168200 . This is a "CALIF CHILDERN SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MTE00889F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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