MEDICARE: MORONGO BASIN AMBULANCE ASSN., INC.

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	3416L0300X	Land Ambulance	1797	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164499877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORONGO BASIN AMBULANCE ASSN., INC.

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:	6335 PARK BLVD.
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-0460
Country	:	US
Telephone Number	:	760-366-8474
Fax Number	:	760-366-8560

Provider Business Practice Location Address
First Line	:	6335 PARK BLVD
Second Line	:
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-2370
Country	:	US
Telephone Number	:	760-366-8474
Fax Number	:	760-366-8560

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	RAMON LOMELI
Credential	:
Telephone Number	:	760-366-8474

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	05/15/2012

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