Provider Demographics
NPI:1194890798
Name:ADVANCED AMBULANCE SERVICE, INC
Entity type:Organization
Organization Name:ADVANCED AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:B
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-844-4444
Mailing Address - Street 1:106 COLONY PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2765
Mailing Address - Country:US
Mailing Address - Phone:770-844-4444
Mailing Address - Fax:770-886-1144
Practice Address - Street 1:106 COLONY PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2765
Practice Address - Country:US
Practice Address - Phone:770-844-4444
Practice Address - Fax:770-886-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058-05341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance