MEDICARE: SAN ANDREAS AMBULANCE

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	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669472023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANDREAS AMBULANCE

Provider Business Mailing Address
First Line	:	PO BOX 1115
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-1115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 ST CHARLES ST
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249
Country	:	US
Telephone Number	:	209-754-5701
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DALE JONES
Credential	:
Telephone Number	:	209-754-5701

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/19/2007

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Directions to “SAN ANDREAS AMBULANCE ” Practice Location

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