Healthcare Provider Details

I. General information

NPI: 1821657115
Provider Name (Legal Business Name): ACTIVE TRANSPORT MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HERON WAY STE A
MERCED CA
95341-8011
US

IV. Provider business mailing address

24 OXFORD AVE
CLOVIS CA
93612-0943
US

V. Phone/Fax

Practice location:
  • Phone: 916-320-6606
  • Fax:
Mailing address:
  • Phone: 559-392-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON BROWN
Title or Position: PARTNER/OWNER
Credential:
Phone: 916-320-6606