Provider Demographics
NPI:1558469296
Name:COUNTY OF EL DORADO
Entity Type:Organization
Organization Name:COUNTY OF EL DORADO
Other - Org Name:EL DORADO COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS AND PREPAREDNESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-6505
Mailing Address - Street 1:2900 FAIRLANE CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-621-6505
Mailing Address - Fax:530-621-2758
Practice Address - Street 1:2900 FAIRLANE CT
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-621-6500
Practice Address - Fax:530-621-2758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF EL DORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA590011926OtherRRB
CAZZZ74789ZMedicaid
CAZZZ74789ZMedicaid