Provider Demographics
NPI:1083719801
Name:AMERICAN MEDICAL RESPONSE MID-ATLANTIC INC
Entity Type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE MID-ATLANTIC INC
Other - Org Name:AMERICAN MEDICAL RESPONSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
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:800-913-9106
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412794300Medicaid
PA0008480620011Medicaid
DC068515598Medicaid
MD212363100Medicaid
FL002501800Medicaid
DC038921600Medicaid
MD205857000Medicaid
DC038921600Medicaid
DC038921600Medicaid
PA0008480620010Medicaid
NJ291016Medicare PIN
NJ509910377Medicare PIN
MD590010377Medicare PIN
NJ590010377Medicare PIN