Healthcare Provider Details

I. General information

NPI: 1588015663
Provider Name (Legal Business Name): AMERICAN SPECIALTY AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 17TH ST
MODESTO CA
95354-1209
US

IV. Provider business mailing address

700 17TH ST
MODESTO CA
95354-1209
US

V. Phone/Fax

Practice location:
  • Phone: 209-505-1035
  • Fax: 209-846-0345
Mailing address:
  • Phone: 209-505-1035
  • Fax: 209-846-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MRS. GIA S SMITH
Title or Position: CEO
Credential:
Phone: 209-505-1035