Provider Demographics
NPI:1558489609
Name:AVENAL DISTRICT AMBULANCE SERVICE
Entity Type:Organization
Organization Name:AVENAL DISTRICT AMBULANCE SERVICE
Other - Org Name:AVENAL DISTRICT HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:BLAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-386-2211
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:709 N. THIRD ST.
Mailing Address - City:AVENAL
Mailing Address - State:CA
Mailing Address - Zip Code:93204-1054
Mailing Address - Country:US
Mailing Address - Phone:559-386-2211
Mailing Address - Fax:559-386-2212
Practice Address - Street 1:709 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1054
Practice Address - Country:US
Practice Address - Phone:559-386-2211
Practice Address - Fax:559-386-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00294FMedicaid
CAZZZ37459ZMedicare PIN