Healthcare Provider Details

I. General information

NPI: 1679565642
Provider Name (Legal Business Name): AJO AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N AJO GILA BND HWY
AJO AZ
85321-1117
US

IV. Provider business mailing address

1850 N AJO GILA BEND HWY
AJO AZ
85321-1117
US

V. Phone/Fax

Practice location:
  • Phone: 520-387-5154
  • Fax: 520-387-6050
Mailing address:
  • Phone: 520-387-5154
  • Fax: 520-387-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number101
License Number StateAZ

VIII. Authorized Official

Name: MRS. SARA COYLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 520-387-5154