Provider Demographics
NPI:1699722298
Name:EASTERN AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:EASTERN AMBULANCE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-227-6078
Mailing Address - Street 1:PO BOX 2812
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2812
Mailing Address - Country:US
Mailing Address - Phone:855-249-2841
Mailing Address - Fax:480-627-6128
Practice Address - Street 1:5921 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-2826
Practice Address - Country:US
Practice Address - Phone:402-731-8401
Practice Address - Fax:402-333-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60503416L0300X
NE5050341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========02Medicaid
NE=========02Medicaid
NE=========02Medicaid
NE983460Medicaid