1629238654 NPI number — FIREMEDIC AMBULANCE CORPORATION

Table of content: (NPI 1629238654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629238654 NPI number — FIREMEDIC AMBULANCE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIREMEDIC AMBULANCE CORPORATION
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:
1629238654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 CALLE ARZUAGA
Provider Second Line Business Mailing Address:
R.P.M. #264 RIO PIEDRAS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00925-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-514-3030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 3 AVE. 65 INFANTERIA KM 15.3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-514-3030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
EFRAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-514-3030

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: TCAMB536 , 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)

  • Identifier: 1629238654 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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