1841388857 NPI number — HUGHSON PARAMEDIC AMBULANCE COMPANY, INC

Table of content: (NPI 1841388857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841388857 NPI number — HUGHSON PARAMEDIC AMBULANCE COMPANY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGHSON PARAMEDIC AMBULANCE COMPANY, 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:
1841388857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUGHSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95326-1719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-883-9177
Provider Business Mailing Address Fax Number:
209-883-4178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2419 CHARLES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGHSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95326-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-883-9177
Provider Business Practice Location Address Fax Number:
209-883-4178
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CROWDER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
209-883-9177

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  103418 , 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: 590005707 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 183594700 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MTE00460F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ25308Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".