Provider Demographics
NPI:1417725219
Name:FRONTLINE AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:FRONTLINE AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-666-2115
Mailing Address - Street 1:1185 HIGHTOWER TRL UNIT 502383
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31150-3127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR STE 3-245
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5399
Practice Address - Country:US
Practice Address - Phone:404-666-2115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance