Organization
TRI VALLEY AMBULANCE SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERARD A MASSE CEP (DIRECTOR OF OPERATIONS)
(928) 785-9019
Entity
Organization
Contact information
Practice address
29118 LOS ANGELES AVE, WELLTON, AZ 85356
(928) 785-9019
(928) 785-3624
Mailing address
PO BOX 958, WELLTON, AZ 85356-0958
(928) 785-9019
(928) 785-3624
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070805
AHCCCS
AZ
01
—
070805-001
MERCY CARE
AZ
Enumeration date
01/19/2007
Last updated
06/03/2008
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