Provider Demographics
NPI:1619013653
Name:MARLBORO HUDSON AMBULANCE AND WHEELCHAIR SERVICE INC
Entity Type:Organization
Organization Name:MARLBORO HUDSON AMBULANCE AND WHEELCHAIR SERVICE INC
Other - Org Name:
Other - Org Type:
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 100330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0330
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:401 CEDAR HILL STREET
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752-3036
Practice Address - Country:US
Practice Address - Phone:978-562-1777
Practice Address - Fax:978-562-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
MA30363416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1715453Medicaid
MA102959OtherBCBSMA
MA8100040OtherEVERCARE
MA1720112Medicaid
MA700292OtherTUFTS HEALTH PLAN
MA702259OtherHPHC
MA3147785OtherCIGNA
MA102959OtherBCBSMA
MA700292OtherTUFTS HEALTH PLAN