=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932292604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5257 VINCENT AVE
-----------------------------------------------------
City | IRWINDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91706-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-633-4600
-----------------------------------------------------
Fax | 626-633-4609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 55418
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90074-5418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-913-9106
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | TIMOTHY JOSEPH DORN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-703-2294
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------