Organization
EASTERN AMBULANCE SERVICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY J FACKOVEC JR. (PRESIDENT)
(781) 569-6003
Entity
Organization
Contact information
Practice address
12 WALNUT HILL PARK, WOBURN, MA 01801-3714
(781) 569-6003
(781) 569-6007
Mailing address
PO BOX 3009, WOBURN, MA 01888-1809
(781) 569-6003
(781) 569-6007
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
3994
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1719289
—
MA
Enumeration date
07/09/2006
Last updated
02/24/2009
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