1174683510 NPI number — UNITED AMBULANCE SERVICE OF CAMBRIDGE INC

Table of content: (NPI 1174683510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174683510 NPI number — UNITED AMBULANCE SERVICE OF CAMBRIDGE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED AMBULANCE SERVICE OF CAMBRIDGE 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:
1174683510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43725-6118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-439-4880
Provider Business Mailing Address Fax Number:
740-439-2371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 CAMPBELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-439-4880
Provider Business Practice Location Address Fax Number:
740-439-2371
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STARR
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
740-439-4880

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020381650 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 020381651 , 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: 000000155067 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590002041 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000206374 . This is a "MT STATE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0550112 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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