MEDICARE: PROMED AMBULANCE SERVICE

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	:	1356679815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	8455 HIGHWAY 85
Second Line	:	BLDG 200, SUITE E
City	:	RIVERDALE
State	:	GA
Zip	:	30274-5115
Country	:	US
Telephone Number	:	678-610-0580
Fax Number	:	678-610-0582

Provider Business Practice Location Address
First Line	:	8455 HIGHWAY 85
Second Line	:	BLDG 200, SUITE E
City	:	RIVERDALE
State	:	GA
Zip	:	30274-5115
Country	:	US
Telephone Number	:	678-610-0580
Fax Number	:	678-610-0582

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANK E MIDDLEBROOKS SR.
Credential	:
Telephone Number	:	678-610-0580

Provider Enumeration Date	:	11/21/2009
Last Update Date	:	11/21/2009

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Directions to “PROMED AMBULANCE SERVICE ” Practice Location

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