Provider Demographics
NPI:1235292129
Name:EMERGENCY MEDICAL FOUNDATION INC
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL FOUNDATION INC
Other - Org Name:EVAC AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-252-4900
Mailing Address - Street 1:112 CARSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5010
Mailing Address - Country:US
Mailing Address - Phone:386-252-4900
Mailing Address - Fax:386-252-4986
Practice Address - Street 1:112 CARSWELL AVE
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-5010
Practice Address - Country:US
Practice Address - Phone:386-252-4900
Practice Address - Fax:386-252-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA0521Medicare ID - Type UnspecifiedMEDICARE