Healthcare Provider Details

I. General information

NPI: 1306896790
Provider Name (Legal Business Name): RANDLE EASTERN AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 NW 107TH AVE
MEDLEY FL
33178-3121
US

IV. Provider business mailing address

PO BOX 402079
ATLANTA GA
30384-2079
US

V. Phone/Fax

Practice location:
  • Phone: 305-718-6400
  • Fax: 305-640-1557
Mailing address:
  • Phone: 800-913-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY JOSEPH DORN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 833-703-2294