Provider Demographics
NPI:1578597886
Name:AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
Other - Org Name:AMERICAN MEDICAL RESPONSE (AMR)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OF REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 55418
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5418
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:879 MARLBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2133
Practice Address - Country:US
Practice Address - Phone:951-782-5200
Practice Address - Fax:951-782-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA007029OtherSCAN HEALTH PLAN
CAMTE00798FOtherMOLINA HEALTH PLAN
CAZZZ89601ZOtherBLUESHIELD OF CALIFORNIA
CA180215802OtherWORKERS COMP DEPT OF LAB
CA007029OtherSCAN HEALTH PLAN
CA007029OtherSCAN HEALTH PLAN
CA590012220Medicare PIN
CA=========925070000OtherCHAMPUS/TRICARE