Provider Demographics
NPI:1518045632
Name:MEDCON AMBULANCE
Entity Type:Organization
Organization Name:MEDCON AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-259-1915
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-0055
Mailing Address - Country:US
Mailing Address - Phone:570-538-4488
Mailing Address - Fax:570-538-1556
Practice Address - Street 1:23000 CONNECTICUT ST
Practice Address - Street 2:#806
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1691
Practice Address - Country:US
Practice Address - Phone:510-259-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30401ZMedicare ID - Type UnspecifiedMEDICARE