Organization
ARIZONA AMBULANCE OF DOUGLAS INC
Active
Organization
ARIZONA AMBULANCE OF DOUGLAS INC
Active
Other names
Arizona Ambulance Transportation
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD VAN HORNE (MANAGING PARTNER)
(909) 578-9526
Entity
Organization
Contact information
Practice address
4266 E INDUSTRY DRIVE, SIERRA VISTA, AZ 85635
(520) 459-4040
Mailing address
PO BOX 1988, SIERRA VISTA, AZ 85636-1988
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189840100
DEPT OF LABOR
AZ
05
—
536237-01
—
AZ
01
—
590014363
RR MEDICARE
AZ
01
—
AZ0000D100066
TRAILBLAZER HEALTH
AZ
01
—
AZ0152110
BCBS
AZ
Enumeration date
12/11/2006
Last updated
12/27/2011
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