Provider Demographics
NPI:1790839702
Name:DARRELL EUGENE FROST DBA NORTHERN SISKIYOU AMBULANCE SERVICE
Entity type:Organization
Organization Name:DARRELL EUGENE FROST DBA NORTHERN SISKIYOU AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MICP
Authorized Official - Phone:530-842-3583
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-0850
Mailing Address - Country:US
Mailing Address - Phone:530-842-3583
Mailing Address - Fax:530-842-6672
Practice Address - Street 1:553 N MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2524
Practice Address - Country:US
Practice Address - Phone:530-842-3583
Practice Address - Fax:530-842-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101765343900000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00243FMedicaid
CAMTN00777FMedicaid
CAMTE00243FMedicaid