1871527887 NPI number — MEDIC AMBULANCE SERVICE INC

Table of content: (NPI 1871527887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871527887 NPI number — MEDIC AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDIC 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:
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:
1871527887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 TEXAS ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94533-5723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-564-9040
Provider Business Mailing Address Fax Number:
916-564-9095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 COUCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-644-1771
Provider Business Practice Location Address Fax Number:
707-644-1784
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIERSON
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
FRANCES
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
916-564-9040

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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: ZZZ81763Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MTE00865F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".