Provider Demographics
NPI:1265400451
Name:PRIDE AMBULANCE COMPANY
Entity type:Organization
Organization Name:PRIDE AMBULANCE COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ONDERLINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-2224
Mailing Address - Street 1:828 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3004
Mailing Address - Country:US
Mailing Address - Phone:269-343-2224
Mailing Address - Fax:269-343-6503
Practice Address - Street 1:208 CRUTCHFIELD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4710
Practice Address - Country:US
Practice Address - Phone:615-889-4445
Practice Address - Fax:615-884-6980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIDE AMBULANCE COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000100173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4060541Medicaid
TN4060541Medicaid