Provider Demographics
NPI:1679565642
Name:AJO AMBULANCE INC
Entity type:Organization
Organization Name:AJO AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-387-5154
Mailing Address - Street 1:1850 N AJO GILA BEND HWY
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-1117
Mailing Address - Country:US
Mailing Address - Phone:520-387-5154
Mailing Address - Fax:520-387-6050
Practice Address - Street 1:1850 N AJO GILA BND HWY
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-1117
Practice Address - Country:US
Practice Address - Phone:520-387-5154
Practice Address - Fax:520-387-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0151350OtherBLUE CROSS BLUE SHIELD
AZ008955Medicaid
AZZRFBJKMedicare ID - Type Unspecified