Healthcare Provider Details

I. General information

NPI: 1326045949
Provider Name (Legal Business Name): ANTELOPE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42540 N. 6TH STREET EAST
LANCASTER CA
93535-5202
US

IV. Provider business mailing address

P.O. BOX 5480
LANCASTER CA
93539-5480
US

V. Phone/Fax

Practice location:
  • Phone: 661-951-1998
  • Fax: 661-951-1188
Mailing address:
  • Phone: 661-951-1998
  • Fax: 661-951-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1834
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1834
License Number StateCA

VIII. Authorized Official

Name: MR. DOUGLAS RICHARD CAIN
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 661-951-1998