Healthcare Provider Details

I. General information

NPI: 1134478852
Provider Name (Legal Business Name): ESCALON COMMUNITY AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 ULLREY AVE
ESCALON CA
95320-8612
US

IV. Provider business mailing address

1480 ULLREY AVE
ESCALON CA
95320-8612
US

V. Phone/Fax

Practice location:
  • Phone: 209-838-3264
  • Fax:
Mailing address:
  • Phone: 209-838-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: BOB PETERSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 209-838-3264