Provider Demographics
NPI:1679662886
Name:AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-733-6600
Mailing Address - Street 1:5995 PHILIPS HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5916
Mailing Address - Country:US
Mailing Address - Phone:904-733-6600
Mailing Address - Fax:904-899-9024
Practice Address - Street 1:5995 PHILIPS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5916
Practice Address - Country:US
Practice Address - Phone:904-733-6600
Practice Address - Fax:904-899-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08813400Medicaid
FLA0008Medicare ID - Type Unspecified