Provider Demographics
NPI:1285194829
Name:REGIONAL AMBULANCE SERVICE, LLC
Entity type:Organization
Organization Name:REGIONAL AMBULANCE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-987-2166
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-0119
Mailing Address - Country:US
Mailing Address - Phone:404-987-2166
Mailing Address - Fax:
Practice Address - Street 1:2054 REX RD STE 5C
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3970
Practice Address - Country:US
Practice Address - Phone:800-404-6454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance