Provider Demographics
NPI:1699866608
Name:KYSTAL AMBULANCE CORPORATION
Entity type:Organization
Organization Name:KYSTAL AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERENTE GENERAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIPOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-316-3219
Mailing Address - Street 1:PMB 20000
Mailing Address - Street 2:BOX 85
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-1233
Mailing Address - Fax:787-731-4643
Practice Address - Street 1:CARR 185 KM 8.1
Practice Address - Street 2:BO CAMPO RICO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0085
Practice Address - Country:US
Practice Address - Phone:787-256-1233
Practice Address - Fax:787-731-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB 3153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR56621Medicare ID - Type UnspecifiedNUMERO PROVEEDOR