Provider Demographics
NPI:1487734349
Name:PRIORITY ONE MEDICAL TRANSPORT, INC.
Entity type:Organization
Organization Name:PRIORITY ONE MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-600-3350
Mailing Address - Street 1:9327 FAIRWAY VIEW PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0968
Mailing Address - Country:US
Mailing Address - Phone:800-600-3350
Mailing Address - Fax:909-948-4492
Practice Address - Street 1:9327 FAIRWAY VIEW PL
Practice Address - Street 2:SUITE 300
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0968
Practice Address - Country:US
Practice Address - Phone:800-600-3350
Practice Address - Fax:909-948-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP168200OtherCALIF CHILDERN SERVICES
CAMTE00889FMedicaid
CAZZZ18043ZMedicare ID - Type UnspecifiedNHIC NORTH
CACGP168200OtherCALIF CHILDERN SERVICES
CAZ482Medicare ID - Type UnspecifiedNHIC SOUTH