Provider Demographics
NPI:1629238654
Name:FIREMEDIC AMBULANCE CORPORATION
Entity Type:Organization
Organization Name:FIREMEDIC AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-514-3030
Mailing Address - Street 1:11 CALLE ARZUAGA
Mailing Address - Street 2:R.P.M. #264 RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3701
Mailing Address - Country:US
Mailing Address - Phone:787-514-3030
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 AVE. 65 INFANTERIA KM 15.3
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-514-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X
PRTCAMB5363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1629238654Medicaid