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General NPI Number Information
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NPI Number | 1518964022
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Entity Type | Organization
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Legal Business Name | MEDIC-1 AMBULANCE SERVICE INC.
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 5462 IRWINDALE AVE STE B
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City | IRWINDALE
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State | CA
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Zip | 91706-2074
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Country | US
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Telephone | 626-385-0440
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Fax | 626-815-2852
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Provider Business Mailing Address
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Address Line | 5462 IRWINDALE AVE STE B
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City | IRWINDALE
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State | CA
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Zip | 91706-2074
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Country | US
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Telephone | 626-385-0440
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Fax | 626-815-2852
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | MR. GORDON SHIPP
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Credential |
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Telephone | 626-385-0440
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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 | 1822
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License Number State | CA
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