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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