Provider Demographics
NPI:1184732091
Name:AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-703-2294
Mailing Address - Street 1:PO BOX 55418
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5418
Mailing Address - Country:US
Mailing Address - Phone:800-913-9106
Mailing Address - Fax:
Practice Address - Street 1:616 FITCH AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2060
Practice Address - Country:US
Practice Address - Phone:805-517-2010
Practice Address - Fax:805-517-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180215100OtherWORKERS COMP DEPT OF LAB
CAMTE00955FOtherMOLINA HEALTH PLAN
CAZZZ56267ZOtherBS OF CA
CA044739OtherSCAN HEALTH PLAN
CACA0000D100251OtherSECTION 1011
CAMTE00955FMedicaid
CAMTE00955FOtherMOLINA HEALTH PLAN
CACA0000D100251OtherSECTION 1011
CA=========930030000OtherCHAMPUS/TRICARE