Provider Demographics
NPI:1326045949
Name:ANTELOPE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:ANTELOPE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-951-1998
Mailing Address - Street 1:P.O. BOX 5480
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-5480
Mailing Address - Country:US
Mailing Address - Phone:661-951-1998
Mailing Address - Fax:661-951-1188
Practice Address - Street 1:42540 N. 6TH STREET EAST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-5202
Practice Address - Country:US
Practice Address - Phone:661-951-1998
Practice Address - Fax:661-951-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1834341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00972FMedicaid
CAMTE00972FMedicaid