1558348854 NPI number — EMERGENCY MEDICAL TRANSPORT INC

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 1558348854 NPI number — EMERGENCY MEDICAL TRANSPORT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY MEDICAL TRANSPORT 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:
6
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:
1558348854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63724
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85082-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-437-1431
Provider Business Mailing Address Fax Number:
602-437-8436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 S INDUSTRIAL PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-437-1431
Provider Business Practice Location Address Fax Number:
602-437-8436
Provider Enumeration Date:
12/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VASSALLO
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT OF BILLING SERVICES
Authorized Official Telephone Number:
602-437-6620

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  75 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 894643 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00148210 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0150760 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".