Provider Demographics
NPI:1235160086
Name:POCOMOKE VOL AMB CO.,INC
Entity Type:Organization
Organization Name:POCOMOKE VOL AMB CO.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4790
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-0036
Mailing Address - Country:US
Mailing Address - Phone:410-479-4790
Mailing Address - Fax:410-479-4793
Practice Address - Street 1:137 8TH ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1128
Practice Address - Country:US
Practice Address - Phone:410-479-4790
Practice Address - Fax:410-479-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD061202200Medicaid
MD406590991Medicare ID - Type UnspecifiedRR MCR
MD061202200Medicaid