Provider Demographics
NPI:1780607515
Name:ACTION MEDICAL SERVICE INC
Entity type:Organization
Organization Name:ACTION MEDICAL SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-9229
Mailing Address - Street 1:1200 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-4130
Mailing Address - Country:US
Mailing Address - Phone:928-289-9229
Mailing Address - Fax:928-289-2745
Practice Address - Street 1:GANADO PLAZA TRAILER PARK SPACE 1
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTION MEDICAL SERVICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ903416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0151910OtherBC/BS
AZ436627001Medicaid
UT=========004Medicaid
AZZ25595Medicare PIN
AZAZ0151910OtherBC/BS