1235351636 NPI number — COMMUNITY AMBULANCE INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235351636 NPI number — COMMUNITY AMBULANCE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY AMBULANCE 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:
Provider Other Organization Name Type Code:
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:
1235351636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9330 MARKET SQUARE DRIVE
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
STREETSBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-626-5450
Provider Business Mailing Address Fax Number:
330-626-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10804 FOREST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARRETTSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-527-4100
Provider Business Practice Location Address Fax Number:
330-527-2671
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPONAUGLE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
330-527-4100

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0262451 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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