Provider Demographics
NPI:1609876929
Name:AMERICAN LEGION POST NO. 108 AMBULANCE SERVICE
Entity Type:Organization
Organization Name:AMERICAN LEGION POST NO. 108 AMBULANCE SERVICE
Other - Org Name:AMERICAN LEGION AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCNANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-223-2963
Mailing Address - Street 1:11350 AMERICAN LEGION DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642
Mailing Address - Country:US
Mailing Address - Phone:209-223-2963
Mailing Address - Fax:209-267-5463
Practice Address - Street 1:11350 AMERICAN LEGION DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642
Practice Address - Country:US
Practice Address - Phone:209-223-2963
Practice Address - Fax:209-267-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00749FMedicaid
CA590480356OtherRRB
CAMTE00749FMedicaid