=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477669489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOP AMBULANCE SERVICE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 CENTRAL ST UNIT 4
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01749-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-562-4518
-----------------------------------------------------
Fax | 978-562-4558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 482
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01749-3264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-562-4518
-----------------------------------------------------
Fax | 978-562-4558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING REPRESENTATIVE
-----------------------------------------------------
Name | MRS. JENNIFER M GOMM SR.
-----------------------------------------------------
Credential | BILLER
-----------------------------------------------------
Telephone | 978-618-1730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 3986
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------