1497058846 NPI number — PATRIOT EMERGENCY MEDICAL SERVICE

Table of content: (NPI 1497058846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497058846 NPI number — PATRIOT EMERGENCY MEDICAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRIOT EMERGENCY MEDICAL SERVICE
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:
LAWRENCE COUNTY EMERGENCY MEDICAL SERVICE
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:
1497058846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4434
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45638-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-532-2222
Provider Business Mailing Address Fax Number:
740-532-4344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2914 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45638-2867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-532-2222
Provider Business Practice Location Address Fax Number:
740-532-4344
Provider Enumeration Date:
12/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROTTER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
740-532-2222

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  440022 , 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: 2530756 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 445015 . This is a "OHIO AMBULETTE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201031600168 . This is a "OHIO SOS CERTIFICATE OF TRADE NAME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 440022 . This is a "OHIO EMERGENCY MEDICAL SERVICES LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02-1458000 . This is a "OHIO BOARD OF PHARMACY" identifier . This identifiers is of the category "OTHER".




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