Provider Demographics
NPI:1124030739
Name:ADVANCED MEDICAL AMBULANCE CORP
Entity Type:Organization
Organization Name:ADVANCED MEDICAL AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-264-5564
Mailing Address - Street 1:PO BOX 2545
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-2545
Mailing Address - Country:US
Mailing Address - Phone:787-264-5564
Mailing Address - Fax:787-264-0703
Practice Address - Street 1:ST 3362 KM 0.4
Practice Address - Street 2:WARD GUAMA
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-2545
Practice Address - Country:US
Practice Address - Phone:787-264-5564
Practice Address - Fax:787-264-0703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED MEDICAL AMBULANCE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-12
Last Update Date:2007-08-08
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-08
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-3883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057695Medicare ID - Type Unspecified