Provider Demographics
NPI:1043875586
Name:TRICARE AMBULANCE SERVICE L.L.C.
Entity Type:Organization
Organization Name:TRICARE AMBULANCE SERVICE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:SASHA
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-282-8657
Mailing Address - Street 1:172 PINE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510
Mailing Address - Country:US
Mailing Address - Phone:888-388-7422
Mailing Address - Fax:
Practice Address - Street 1:172 PINE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510
Practice Address - Country:US
Practice Address - Phone:888-388-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty