Provider Demographics
NPI:1972802601
Name:AMBULANCE SERVICE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:AMBULANCE SERVICE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:HOWELL
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:678-343-2020
Mailing Address - Street 1:2305 DANBURY LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-7311
Mailing Address - Country:US
Mailing Address - Phone:678-343-2020
Mailing Address - Fax:
Practice Address - Street 1:2305 DANBURY LN
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-7311
Practice Address - Country:US
Practice Address - Phone:678-343-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G595426OtherMEDICARE PTAN
GA003129426AMedicaid