Arcata-Mad River Ambulance LLC
Organization Active NPI Land Ambulance · Arcata, CA
NPI 1114430998 · NPPES record last updated Sep 15, 2025
Key facts
- NPI
- 1114430998
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- ARCATA-MAD RIVER AMBULANCE LLC
- Practice address
- 220 F St
Arcata, CA 95521-6616 - Phone
- (707) 822-3353
- Fax
- (707) 822-9628
- NPI assigned
- Nov 15, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- ARCATA-MAD RIVER AMBULANCE LLC
Authorized official
- Name
- Timothy Joseph Dorn
- Title
- Chief Administrative Officer
- Phone
- (833) 703-2294
Parent organization (reported in NPPES) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180119000570 | CA | Part B Supplier - Ambulance Service Supplier | 0941569990 | Practice locations: McKinleyville, CA; Arcata, CA |
National Provider Directory
- Part of
- Arcata-Mad River Ambulance LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | |||
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
220 F St
Arcata, CA 95521-6616
Mailing address
PO Box 742464
Los Angeles, CA 90074-2464
Phone (800) 913-9106
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2105498 | Medicaid | WA | |
| 1114430998 | Medicaid | CA | |
| 500763575 | Medicaid | OR |
Other providers in Arcata, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.