Provider Demographics
NPI:1629003157
Name:IMPULSE AMBULANCE, INC.
Entity Type:Organization
Organization Name:IMPULSE AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:NEIBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-982-3500
Mailing Address - Street 1:12527 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5321
Mailing Address - Country:US
Mailing Address - Phone:818-982-3500
Mailing Address - Fax:818-982-5400
Practice Address - Street 1:12527 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5321
Practice Address - Country:US
Practice Address - Phone:818-982-3500
Practice Address - Fax:818-982-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01169FMedicaid
CAMTE01169FMedicaid