Healthcare Provider Details

I. General information

NPI: 1780607515
Provider Name (Legal Business Name): ACTION MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GANADO PLAZA TRAILER PARK SPACE 1
GANADO AZ
86505
US

IV. Provider business mailing address

1200 E SECOND ST
WINSLOW AZ
86047-4130
US

V. Phone/Fax

Practice location:
  • Phone: 928-755-6195
  • Fax:
Mailing address:
  • Phone: 928-289-9229
  • Fax: 928-289-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number90
License Number StateAZ

VIII. Authorized Official

Name: MRS. CYNTHIA K STEWARD
Title or Position: PRESIDENT
Credential:
Phone: 928-289-9229