Provider Demographics
NPI:1356679815
Name:PROMED AMBULANCE SERVICE
Entity type:Organization
Organization Name:PROMED AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIDDLEBROOKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-610-0580
Mailing Address - Street 1:8455 HIGHWAY 85
Mailing Address - Street 2:BLDG 200, SUITE E
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-5115
Mailing Address - Country:US
Mailing Address - Phone:678-610-0580
Mailing Address - Fax:678-610-0582
Practice Address - Street 1:8455 HIGHWAY 85
Practice Address - Street 2:BLDG 200, SUITE E
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-5115
Practice Address - Country:US
Practice Address - Phone:678-610-0580
Practice Address - Fax:678-610-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance