MEDICARE: COMTRANS AMBULANCE SERVICE INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	EMS2781	AZ

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00185070	OTHER	AZ	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AZ0152370	OTHER	AZ	BCBS

NPI Number	:	1992782296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMTRANS AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 63724
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-3724
Country	:	US
Telephone Number	:	602-437-1431
Fax Number	:	602-437-8436

Provider Business Practice Location Address
First Line	:	2495 S INDUSTRIAL PARK AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-1804
Country	:	US
Telephone Number	:	602-437-1431
Fax Number	:	602-437-8436

Authorized Official
Title or Position	:	VICE PRESIDENT OF BILLING SERVICES
Name	:	MR. RALPH J VASSALLO JR.
Credential	:
Telephone Number	:	602-437-6620

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	11/04/2009

2495 S INDUSTRIAL PARK AVE
TEMPE, AZ
85282-1804

Practice Phone: 602-437-1431
Practice Fax: 602-437-8436

1804 W ELLIOT RD
TEMPE, AZ
85284