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General NPI Number Information
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NPI Number | 1639683378
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Entity Type | Organization
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Legal Business Name | AMG PREMIRE, INC.
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 600 N MOUNTAIN AVE STE C201
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City | UPLAND
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State | CA
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Zip | 91786-4367
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Country | US
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Telephone | 909-740-3217
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Fax | 888-636-4512
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Provider Business Mailing Address
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Address Line | 600 N MOUNTAIN AVE STE C201
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City | UPLAND
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State | CA
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Zip | 91786-4367
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Country | US
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Telephone | 909-740-3217
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Fax | 888-636-4512
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW HANNA
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Credential |
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Telephone | 909-740-3217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | TCP0037598-P
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License Number State | CA
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