Organization
BASIC LIFE SUPPORT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J HALL (PRESIDENT)
(760) 559-3616
Entity
Organization
Contact information
Practice address
2250 HIWAY 95, #556, BULLHEAD CITY, AZ 86442-9013
(760) 559-3616
Mailing address
2250 HIWAY 95, #556, BULLHEAD CITY, AZ 86442-9013
(760) 559-3616
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
D05399766
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192341
AHCCCS
AZ
Enumeration date
10/02/2007
Last updated
10/02/2007
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