Provider Demographics
NPI:1144386111
Name:HEARTLAND PARAMEDICS-CSA 69 COUNTY SERVICE AREA 69 EMS
Entity type:Organization
Organization Name:HEARTLAND PARAMEDICS-CSA 69 COUNTY SERVICE AREA 69 EMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS ADMINNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DORMANN
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-245-4231
Mailing Address - Street 1:5510 OVERLAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1239
Mailing Address - Country:US
Mailing Address - Phone:619-285-6429
Mailing Address - Fax:
Practice Address - Street 1:5510 OVERLAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1239
Practice Address - Country:US
Practice Address - Phone:619-285-6429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00993FMedicaid
CA590013869Medicare PIN
ZA487Medicare PIN