Provider Demographics
NPI:1982893715
Name:GOL CROSS AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:GOL CROSS AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-596-6735
Mailing Address - Street 1:436 ROSWELL ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2067
Mailing Address - Country:US
Mailing Address - Phone:678-355-1775
Mailing Address - Fax:678-355-1726
Practice Address - Street 1:436 ROSWELL ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2067
Practice Address - Country:US
Practice Address - Phone:678-355-1775
Practice Address - Fax:678-355-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03333341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance