Healthcare Provider Details

I. General information

NPI: 1407864341
Provider Name (Legal Business Name): BLYTHE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S 1ST ST
BLYTHE CA
92225-2518
US

IV. Provider business mailing address

PO BOX 55418
LOS ANGELES CA
90074-5418
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-8460
  • Fax: 760-883-5011
Mailing address:
  • Phone: 800-913-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberA125
License Number StateCA

VIII. Authorized Official

Name: TIMOTHY JOSEPH DORN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 833-703-2294