MEDICARE: KMA EMERGENCY SERVICES, 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	A145	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	:	1508939943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMA EMERGENCY SERVICES, INC.

Provider Business Mailing Address
First Line	:	3972 BARRANCA PKWY
Second Line	:	SUITE J430
City	:	IRVINE
State	:	CA
Zip	:	92606-8656
Country	:	US
Telephone Number	:	510-614-1420
Fax Number	:	510-614-1429

Provider Business Practice Location Address
First Line	:	14275 WICKS BLVD
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-5613
Country	:	US
Telephone Number	:	510-614-1420
Fax Number	:	510-614-1429

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ERIK MANDLER
Credential	:
Telephone Number	:	949-981-0299

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	01/10/2018

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