Provider Demographics
NPI:1679660674
Name:AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA
Other - Org Name:AMERICAN MEDICAL RESPONSE
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 1:1055 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3328
Practice Address - Country:US
Practice Address - Phone:661-945-9300
Practice Address - Fax:661-945-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31545ZMedicaid
CAZZZ92796ZOtherBLUESHIELD OF CALIFORNIA
CAZZZ56267ZOtherBLUESHIELD OF CALIFORNIA
CAZA458Medicare PIN
CAZZZ92796ZOtherBLUESHIELD OF CALIFORNIA