Provider Demographics
NPI:1952138521
Name:ST. MARK AMBULANCE LLC
Entity type:Organization
Organization Name:ST. MARK AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK VICTOR
Authorized Official - Middle Name:ALON
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT
Authorized Official - Phone:650-880-2588
Mailing Address - Street 1:207 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-6305
Mailing Address - Country:US
Mailing Address - Phone:650-880-2588
Mailing Address - Fax:
Practice Address - Street 1:207 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6305
Practice Address - Country:US
Practice Address - Phone:650-880-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREGENTUM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance