1487092862 NPI number — PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC

Table of content: (NPI 1487092862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487092862 NPI number — PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTSMOUTH EMERGENCY 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:
Provider Other Organization Name Type Code:
6
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:
1487092862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2796 GALLIA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-354-3122
Provider Business Mailing Address Fax Number:
740-351-0679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 HAUSER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SHORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-3122
Provider Business Practice Location Address Fax Number:
740-351-0679
Provider Enumeration Date:
06/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ESTEP
Authorized Official First Name:
RACHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
740-354-3122

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1676 / 1677 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 1676 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1677 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 1677 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1676 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0096759 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1487092862 . This is a "KY MEDICARE PROVIDER NUMBER K093870" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100189640 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100260300 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3159442 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100174460 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100260270 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96759 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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