=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396742912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACTION MEDICAL SERVICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2005
-----------------------------------------------------
Last Update Date | 03/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 E SECOND ST
-----------------------------------------------------
City | WINSLOW
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86047-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-289-9229
-----------------------------------------------------
Fax | 928-829-6445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 E SECOND ST
-----------------------------------------------------
City | WINSLOW
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86047-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-289-9229
-----------------------------------------------------
Fax | 928-829-6445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CYNTHIA K STEWARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-289-9229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 104
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------