Healthcare Provider Details

I. General information

NPI: 1568711299
Provider Name (Legal Business Name): RG AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4227 SAINT LUCIE BLVD
FORT PIERCE FL
34946-9000
US

IV. Provider business mailing address

2766 NW 62ND ST
MIAMI FL
33147-7662
US

V. Phone/Fax

Practice location:
  • Phone: 888-876-2100
  • Fax:
Mailing address:
  • Phone: 772-465-1111
  • Fax: 772-466-1150

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: MR. CHARLES MAYMON
Title or Position: CEO
Credential:
Phone: 888-876-2100