Provider Demographics
NPI:1699043240
Name:TCOFB ACM AMBULANCE
Entity Type:Organization
Organization Name:TCOFB ACM AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-794-6206
Mailing Address - Street 1:PO BOX 4261
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4261
Mailing Address - Country:US
Mailing Address - Phone:973-794-6206
Mailing Address - Fax:973-949-3053
Practice Address - Street 1:431 WAGARAW RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1344
Practice Address - Country:US
Practice Address - Phone:973-794-6206
Practice Address - Fax:973-949-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-11
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA0212089341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ238381Medicare PIN