MEDICARE: FRONTLINE AMBULANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance

General Provider Information

NPI Number	:	1134879877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTLINE AMBULANCE LLC

Provider Business Mailing Address
First Line	:	5 BRAYTON CT
Second Line	:
City	:	LADERA RANCH
State	:	CA
Zip	:	92694-1359
Country	:	US
Telephone Number	:	619-947-9606
Fax Number	:

Provider Business Practice Location Address
First Line	:	12862 GARDEN GROVE BLVD STE H
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-2021
Country	:	US
Telephone Number	:	619-947-9606
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. TALMADGE CLINE
Credential	:
Telephone Number	:	619-947-9606

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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Directions to “FRONTLINE AMBULANCE LLC ” Practice Location

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