Provider Demographics
NPI:1891841615
Name:GUARDIAN AMBULANCE CORPORATION
Entity type:Organization
Organization Name:GUARDIAN AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-686-1199
Mailing Address - Street 1:37 MARSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2312
Mailing Address - Country:US
Mailing Address - Phone:800-928-1315
Mailing Address - Fax:978-887-1176
Practice Address - Street 1:37 MARSTON ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2312
Practice Address - Country:US
Practice Address - Phone:800-927-1315
Practice Address - Fax:978-887-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39843416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA095359OtherBLUE CROSS PROVIDER NUMBE
MA1714708Medicaid
MA0009001OtherNEIGHBORHOOD HEALTH PLAN
MA590006835Medicare PIN
MA095359Medicare PIN