Provider Demographics
NPI:1962576660
Name:PROGRESSIVE AMBULANCE, INC.
Entity type:Organization
Organization Name:PROGRESSIVE AMBULANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUVER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-499-3902
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93556-0157
Mailing Address - Country:US
Mailing Address - Phone:760-375-6531
Mailing Address - Fax:760-371-1115
Practice Address - Street 1:350 E RIDGECREST BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3928
Practice Address - Country:US
Practice Address - Phone:760-375-6531
Practice Address - Fax:760-371-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17993416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00293FMedicaid
CAMTE00293FMedicaid