=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326045949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTELOPE AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2005
-----------------------------------------------------
Last Update Date | 02/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42540 N. 6TH STREET EAST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93535-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-951-1998
-----------------------------------------------------
Fax | 661-951-1188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 5480
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93539-5480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-951-1998
-----------------------------------------------------
Fax | 661-951-1188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE SECRETARY
-----------------------------------------------------
Name | MR. DOUGLAS RICHARD CAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-951-1998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1834
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 1834
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------