Healthcare Provider Details

I. General information

NPI: 1790839702
Provider Name (Legal Business Name): DARRELL EUGENE FROST DBA NORTHERN SISKIYOU AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 N MAIN ST
YREKA CA
96097-2524
US

IV. Provider business mailing address

PO BOX 850
YREKA CA
96097-0850
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-3583
  • Fax: 530-842-6672
Mailing address:
  • Phone: 530-842-3583
  • Fax: 530-842-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number101765
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number101765
License Number StateCA

VIII. Authorized Official

Name: MR. DARRELL FROST
Title or Position: OWNER
Credential: MICP
Phone: 530-842-3583