1730309030 NPI number — FIRST CLASS AMBULANCE INC

Table of content: (NPI 1730309030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730309030 NPI number — FIRST CLASS AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CLASS AMBULANCE 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:
1730309030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 1 BOX 37154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-9101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-236-5291
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RD 354 KM 7.5 SECTOR LA VIOLETA
Provider Second Line Business Practice Location Address:
BO LEGUIZAMO
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-638-8941
Provider Business Practice Location Address Fax Number:
787-818-0429
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTALVO ACEVEDO
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PROPIETARIA/PRESIDENTA
Authorized Official Telephone Number:
787-236-5291

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC AMB 464 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50802 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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