Provider Demographics
NPI:1962439026
Name:MEDICWEST AMBULANCE, INC
Entity type:Organization
Organization Name:MEDICWEST AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-437-6620
Mailing Address - Street 1:PO BOX 61804
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-1804
Mailing Address - Country:US
Mailing Address - Phone:602-437-1431
Mailing Address - Fax:
Practice Address - Street 1:9 W DELHI AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7836
Practice Address - Country:US
Practice Address - Phone:602-437-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1000001-0353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC0808OtherBCBS
NVV34210Medicare ID - Type Unspecified
NVCC0808OtherBCBS