Provider Demographics
NPI:1366550360
Name:HEMET VALLEY AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:HEMET VALLEY 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 1:208 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-2984
Practice Address - Country:US
Practice Address - Phone:951-765-3900
Practice Address - Fax:951-652-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA198180600OtherWORKERS' COMP DEPT OF LAB
CAZZZ30874ZOtherMOLINA HEALTH PLAN
CA011069OtherSCAN HEALTH PLAN
CAZZZ30874ZMedicaid
CAZZZ89654ZOtherBLUESHIELD OF CALIFORNIA
CAZZZ89654ZOtherBLUESHIELD OF CALIFORNIA
CAZZZ30874ZOtherMOLINA HEALTH PLAN
CAZZZ89654ZMedicare PIN
CAZZZ89654ZOtherBLUESHIELD OF CALIFORNIA