1578065595 NPI number — PINNACLE AMBULANCE LLC

Table of content: (NPI 1578065595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578065595 NPI number — PINNACLE AMBULANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE AMBULANCE LLC
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:
TRUST AMBULANCE
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:
1578065595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 CROSSTOWN DR STE 257
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-371-8818
Provider Business Mailing Address Fax Number:
678-364-7374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2839 MOUNT ZION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-6822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-371-8818
Provider Business Practice Location Address Fax Number:
678-364-7373
Provider Enumeration Date:
03/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SABBAGH
Authorized Official First Name:
NABIH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-371-8818

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  AMB2017024 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AMB2017024 . This is a "LAND AMBULANCE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com