Provider Demographics
NPI:1568462604
Name:SYMONS EMERGENCY SPECIALTIES, INC.
Entity Type:Organization
Organization Name:SYMONS EMERGENCY SPECIALTIES, INC.
Other - Org Name:SYMONS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:
Authorized Official - Last Name:SYMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-873-8904
Mailing Address - Street 1:18592 CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1604
Mailing Address - Country:US
Mailing Address - Phone:909-880-2979
Mailing Address - Fax:
Practice Address - Street 1:214 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3448
Practice Address - Country:US
Practice Address - Phone:760-873-8904
Practice Address - Fax:760-873-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590015099OtherRRB
CAMTE00914FMedicaid
CAZZZ23210ZMedicare PIN