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General NPI Number Information
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NPI Number | 1982757282
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Entity Type | Organization
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Legal Business Name | TRI VALLEY AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 29118 LOS ANGELES AVE
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City | WELLTON
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State | AZ
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Zip | 85356
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Country | US
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Telephone | 928-785-9019
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Fax | 928-785-3624
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Provider Business Mailing Address
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Address Line | PO BOX 958
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City | WELLTON
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State | AZ
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Zip | 85356-0958
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Country | US
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Telephone | 928-785-9019
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Fax | 928-785-3624
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | GERARD A MASSE
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Credential | CEP
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Telephone | 928-785-9019
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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 |
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License Number State | AZ
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