Provider Demographics
NPI:1023067717
Name:A1 PRIMAVERA AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:A1 PRIMAVERA AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-644-0848
Mailing Address - Street 1:RR 2 BOX 6901
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9600
Mailing Address - Country:US
Mailing Address - Phone:939-644-0848
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 172 KM 7.5
Practice Address - Street 2:BO BAYAMON SECT CERTENEJAS 2
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:939-644-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 3233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056712Medicare ID - Type UnspecifiedAMBULANCE LAND