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General NPI Number Information
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NPI Number | 1205996246
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Entity Type | Organization
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Legal Business Name | ARIZONA AMBULANCE OF DOUGLAS INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 4266 E INDUSTRY DRIVE
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 520-459-4040
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1988
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-1988
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | EDWARD VAN HORNE
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Credential |
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Telephone | 909-578-9526
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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 | AZ
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