Healthcare Provider Details

I. General information

NPI: 1679803134
Provider Name (Legal Business Name): EXPLORER - 1 AMBULANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 E COMPTON BLVD
COMPTON CA
90221-3306
US

IV. Provider business mailing address

PO BOX 4639
COMPTON CA
90224-4639
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-3971
  • Fax:
Mailing address:
  • Phone: 310-537-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberP20823
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License NumberP20823
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberP20823
License Number StateCA

VIII. Authorized Official

Name: MR. TIMOTHY L. LEE II
Title or Position: CHIEF, EMS OPERATIONS
Credential: PARAMEDIC
Phone: 310-892-6437