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General NPI Number Information
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NPI Number | 1013521491
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Entity Type | Organization
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Legal Business Name | HLA AMBULANCE LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 43 AMANDA LN
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City | PALMETTO
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State | GA
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Zip | 30268
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Country | US
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Telephone | 404-576-0964
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Fax |
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Provider Business Mailing Address
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Address Line | 43 AMANDA LN
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City | PALMETTO
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State | GA
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Zip | 30268
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Country | US
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Telephone | 404-576-0964
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Fax |
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Authorized Official
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Title or Position | C.O.O
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Name | MR. JASON FLOYD LA COSTE
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Credential |
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Telephone | 404-576-0964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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