Provider Demographics
NPI:1558348854
Name:EMERGENCY MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL TRANSPORT INC
Other - Org Name:AMERICAN AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF BILLING SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:VASSALLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-437-6620
Mailing Address - Street 1:PO BOX 63724
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-3724
Mailing Address - Country:US
Mailing Address - Phone:602-437-1431
Mailing Address - Fax:602-437-8436
Practice Address - Street 1:2495 S INDUSTRIAL PARK AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1804
Practice Address - Country:US
Practice Address - Phone:602-437-1431
Practice Address - Fax:602-437-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894643Medicaid
AZP00148210OtherRR MEDICARE
AZAZ0150760OtherBCBS
AZ894643Medicaid
W08293Medicare UPIN