Provider Demographics
NPI:1033127014
Name:EXETER DISTRICT AMBULANCE
Entity Type:Organization
Organization Name:EXETER DISTRICT AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-594-5250
Mailing Address - Street 1:302 EAST PALM STREET
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221
Mailing Address - Country:US
Mailing Address - Phone:559-594-5250
Mailing Address - Fax:559-592-2301
Practice Address - Street 1:302 EAST PALM STREET
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221
Practice Address - Country:US
Practice Address - Phone:559-594-5250
Practice Address - Fax:559-592-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMB05007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00289FMedicaid
CAMTE00289FMedicaid