Provider Demographics
NPI:1245231117
Name:PATRIOT AMBULANCE, INC.
Entity type:Organization
Organization Name:PATRIOT AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-367-5000
Mailing Address - Street 1:248 MILL RD
Mailing Address - Street 2:BLDG 2, UNIT 2
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4165
Mailing Address - Country:US
Mailing Address - Phone:978-367-5000
Mailing Address - Fax:978-367-5017
Practice Address - Street 1:248 MILL RD
Practice Address - Street 2:BLDG 2, UNIT 2
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4165
Practice Address - Country:US
Practice Address - Phone:978-367-5000
Practice Address - Fax:978-367-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3747341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1707736Medicaid
MA029159Medicare ID - Type Unspecified