1548350572 NPI number — AMERICAN AMBULETTE & AMBULANCE SERVICE, INC

Table of content: (NPI 1548350572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548350572 NPI number — AMERICAN AMBULETTE & AMBULANCE SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN AMBULETTE & AMBULANCE SERVICE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
D/B/A MEDCORP AND D/B/A LIFE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548350572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2107 JERGENS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45404-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-727-0544
Provider Business Mailing Address Fax Number:
419-727-0539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 6TH STREET
Provider Second Line Business Practice Location Address:
D/B/A LIFE
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-6169
Provider Business Practice Location Address Fax Number:
937-237-8773
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
URBANSKI
Authorized Official First Name:
JODI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
419-727-0544

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  1676 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 570092 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416S0300X , with the licence number: 1657 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , with the licence number: 1271 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0429129 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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