Eastern Ambulance Service, LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

3994 Issued in MA

Legal business name

EASTERN AMBULANCE SERVICE, LLC

Practice address

12 Walnut Hill Park
Woburn, MA 01801-3714

Phone

(781) 569-6003

Fax

(781) 569-6007

NPI assigned

Jul 9, 2006

Last updated

Feb 24, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Henry J Fackovec Jr.

Title

President

Phone

(781) 569-6003

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235433600000",
    "number": "1336172790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3009",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018881809",
            "telephone_number": "781-569-6003",
            "fax_number": "781-569-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 WALNUT HILL PARK",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018013714",
            "telephone_number": "781-569-6003",
            "fax_number": "781-569-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN AMBULANCE SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2009-02-24",
        "status": "A",
        "authorized_official_last_name": "FACKOVEC",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-569-6003",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MA",
            "license": "3994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1719289",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Woburn, MA
• Providers in Woburn, MA by specialty
• Land Ambulance in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.