Healthcare Provider Details

I. General information

NPI: 1487884987
Provider Name (Legal Business Name): PROFESSIONAL AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 RIVER AVE
PROVIDENCE RI
02908
US

IV. Provider business mailing address

52 RIVER AVE
PROVIDENCE RI
02908
US

V. Phone/Fax

Practice location:
  • Phone: 401-286-7006
  • Fax: 401-274-8688
Mailing address:
  • Phone: 401-286-7006
  • Fax: 401-274-8688

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: MRS. BRENDA BAGINSKI
Title or Position: OWNER/MANAGER
Credential:
Phone: 401-286-7006