MEDICARE: ABUNDANT CARE AMBULANCE SERVICE, 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	10080	TN

General Provider Information

NPI Number	:	1235317843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT CARE AMBULANCE SERVICE, INC.

Provider Business Mailing Address
First Line	:	3590 WINCHEST CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-8113
Country	:	US
Telephone Number	:	901-363-5686
Fax Number	:	901-363-1160

Provider Business Practice Location Address
First Line	:	3590 WINCHEST CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-8113
Country	:	US
Telephone Number	:	901-363-5686
Fax Number	:	901-363-1160

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. STEPHAN D LEGGETT
Credential	:
Telephone Number	:	901-363-5686

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	01/29/2024

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