Provider Demographics
NPI:1073977484
Name:AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC.
Entity Type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-495-1220
Mailing Address - Street 1:PO BOX 409880
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9880
Mailing Address - Country:US
Mailing Address - Phone:303-495-1748
Mailing Address - Fax:
Practice Address - Street 1:6525 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5533
Practice Address - Country:US
Practice Address - Phone:410-328-1101
Practice Address - Fax:800-498-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073977484OtherTRICARE NORTH
MD526998Medicare PIN