Provider Demographics
NPI:1932652815
Name:MARICOPA AMBULANCE, LLC
Entity Type:Organization
Organization Name:MARICOPA AMBULANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE INTEGRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-597-4911
Mailing Address - Street 1:PO BOX 660030
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0030
Mailing Address - Country:US
Mailing Address - Phone:844-597-4911
Mailing Address - Fax:866-687-2796
Practice Address - Street 1:10234 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-1931
Practice Address - Country:US
Practice Address - Phone:480-485-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210198Medicaid
AZZ195151Medicare PIN