1932292604 NPI number — AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932292604 NPI number — AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA
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:
AMERICAN MEDICAL RESPONSE
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:
1932292604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55418
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-5418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-913-9106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5257 VINCENT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRWINDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91706-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-633-4600
Provider Business Practice Location Address Fax Number:
626-633-4609
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP OF REVENUE MANAGEMENT
Authorized Official Telephone Number:
833-703-2294

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZ62795Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ56267Z . This is a "BLUESHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ31545Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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