Provider Demographics
NPI:1679803134
Name:EXPLORER - 1 AMBULANCE SERVICES LLC
Entity Type:Organization
Organization Name:EXPLORER - 1 AMBULANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, EMS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:II
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:310-892-6437
Mailing Address - Street 1:PO BOX 4639
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90224-4639
Mailing Address - Country:US
Mailing Address - Phone:310-537-3971
Mailing Address - Fax:
Practice Address - Street 1:1040 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3306
Practice Address - Country:US
Practice Address - Phone:310-537-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP20823341600000X, 343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)