Provider Demographics
NPI:1417118753
Name:FIRST DUE MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:FIRST DUE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-488-4087
Mailing Address - Street 1:9018 BALBOA BLVD # 558
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2610
Mailing Address - Country:US
Mailing Address - Phone:818-488-4087
Mailing Address - Fax:
Practice Address - Street 1:8113 ORION AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1435
Practice Address - Country:US
Practice Address - Phone:818-488-4087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1951OtherCHP LICENSE #
CA=========OtherFEDERAL TAX ID