Provider Demographics
NPI:1952448755
Name:WHITE MOUNTAIN AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:WHITE MOUNTAIN AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:I
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-333-4202
Mailing Address - Street 1:PO BOX 1670
Mailing Address - Street 2:
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-1670
Mailing Address - Country:US
Mailing Address - Phone:928-333-4202
Mailing Address - Fax:928-333-5914
Practice Address - Street 1:118 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5104
Practice Address - Country:US
Practice Address - Phone:928-333-4202
Practice Address - Fax:928-333-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZRMBBCMedicare UPIN