Provider Demographics
NPI:1003838046
Name:MEDFLEET AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:MEDFLEET AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYDELL
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-222-2244
Mailing Address - Street 1:9960 CAMPO RD
Mailing Address - Street 2:105
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1605
Mailing Address - Country:US
Mailing Address - Phone:619-222-2244
Mailing Address - Fax:619-222-2843
Practice Address - Street 1:9960 CAMPO RD
Practice Address - Street 2:105
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1605
Practice Address - Country:US
Practice Address - Phone:619-222-2244
Practice Address - Fax:619-222-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1867341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01176FMedicaid
CAMTE01176FMedicaid