Provider Demographics
NPI:1518964022
Name:MEDIC-1 AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:MEDIC-1 AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-385-0440
Mailing Address - Street 1:5462 IRWINDALE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2074
Mailing Address - Country:US
Mailing Address - Phone:626-385-0440
Mailing Address - Fax:626-815-2852
Practice Address - Street 1:5462 IRWINDALE AVE
Practice Address - Street 2:STE B
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-2074
Practice Address - Country:US
Practice Address - Phone:626-385-0440
Practice Address - Fax:626-815-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01065FMedicaid
CA2368718OtherCALIF. CORPORATION #
CA1822OtherCHP LICENSE #
CA2368718OtherCALIF. CORPORATION #
CA590015059Medicare ID - Type UnspecifiedRR MEDICARE PROVIDER #