MEDICARE: FIRST AMBULANCE PR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	1866	PR

General Provider Information

NPI Number	:	1285057711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST AMBULANCE PR

Provider Business Mailing Address
First Line	:	105-220 WESTERN AUTO PLAZA
Second Line	:
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976-0000
Country	:	US
Telephone Number	:	939-628-0115
Fax Number	:	787-755-6560

Provider Business Practice Location Address
First Line	:	105-220 WESTERN AUTO PLAZA
Second Line	:
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976-0000
Country	:	US
Telephone Number	:	939-628-0115
Fax Number	:	787-755-6560

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JACOB MANUEL LOPEZ-COLON
Credential	:
Telephone Number	:	939-628-0115

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	02/04/2014

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Directions to “FIRST AMBULANCE PR ” Practice Location

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