Healthcare Provider Details

I. General information

NPI: 1376509612
Provider Name (Legal Business Name): ADVANCED AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 W 130TH ST
N ROYALTON OH
44133
US

IV. Provider business mailing address

1026 PEARL RD STE 5
BRUNSWICK OH
44212
US

V. Phone/Fax

Practice location:
  • Phone: 440-230-5339
  • Fax: 440-230-5329
Mailing address:
  • Phone: 440-230-5339
  • Fax: 440-230-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. EDMUND H GATES JR.
Title or Position: CEO
Credential:
Phone: 440-230-5339