1598989378 NPI number — PORTSMOUTH AMBULANCE INC

Table of content: (NPI 1598989378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598989378 NPI number — PORTSMOUTH AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTSMOUTH 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:
1598989378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1860
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41105-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-353-7553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1536 WINCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-353-7553
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEERE
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
606-465-7373

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  730102 , 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: 0780212 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59014451 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55000285 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56017007 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000186402 . This is a "BLUE CROSS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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