Healthcare Provider Details

I. General information

NPI: 1326194317
Provider Name (Legal Business Name): ANDERSON VALLEY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 AIRPORT RD
BOONVILLE CA
95415-9133
US

IV. Provider business mailing address

PO BOX 144
BOONVILLE CA
95415
US

V. Phone/Fax

Practice location:
  • Phone: 707-895-3123
  • Fax: 707-895-2963
Mailing address:
  • Phone: 707-895-3123
  • Fax: 707-895-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberA142
License Number StateCA

VIII. Authorized Official

Name: MR. ARTHUR M HATCHER
Title or Position: GENERAL MANAGER
Credential:
Phone: 707-895-3123