1467452714 NPI number — J&C AMBULANCE SERVICE, INC.

Table of content: (NPI 1467452714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467452714 NPI number — J&C AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J&C 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:
LIFECARE MEDICAL SERVICES, INC.
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:
1467452714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 WHIPPLE AVENUE NW
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
NORTH CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44720-7167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-899-0022
Provider Business Mailing Address Fax Number:
330-484-2932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 WHIPPLE AVENUE NW
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
NORTH CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44720-7167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-899-0022
Provider Business Practice Location Address Fax Number:
330-484-2932
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
JACOB
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-899-0022

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  760082 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2209658 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2286048 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2319708 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2403698 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080039100 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000195082 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2169540 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128375200 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2169577 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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