MEDICARE: RG AMBULANCE SERVICE II, 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	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1639740897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RG AMBULANCE SERVICE II, LLC.

Provider Business Mailing Address
First Line	:	2766 NW 62ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-7662
Country	:	US
Telephone Number	:	305-779-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	3747 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4627
Country	:	US
Telephone Number	:	407-822-3700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAYMOND GONZALEZ
Credential	:
Telephone Number	:	305-779-0505

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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