Provider Demographics
NPI:1275823122
Name:EXCELSIOR AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:EXCELSIOR AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-278-1725
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-0979
Mailing Address - Country:US
Mailing Address - Phone:912-367-0300
Mailing Address - Fax:912-454-5100
Practice Address - Street 1:153 N MCDONALD ST
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-6015
Practice Address - Country:US
Practice Address - Phone:912-367-0300
Practice Address - Fax:912-454-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport