1558469296 NPI number — COUNTY OF EL DORADO

Table of content: (NPI 1558469296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558469296 NPI number — COUNTY OF EL DORADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF EL DORADO
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:
EL DORADO COUNTY AMBULANCE
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:
1558469296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 FAIRLANE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLACERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-621-6505
Provider Business Mailing Address Fax Number:
530-621-2758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 FAIRLANE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6500
Provider Business Practice Location Address Fax Number:
530-621-2758
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EMS AND PREPAREDNESS MANAGER
Authorized Official Telephone Number:
530-621-6505

Provider Taxonomy Codes

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

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

  • Identifier: 590011926 . This is a "RRB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ74789Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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