MEDICARE: BROOKESIDE AMBULANCE SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	480022	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891795829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKESIDE AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	640 PHILLIPS AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612
Country	:	US
Telephone Number	:	419-476-7442
Fax Number	:	419-476-9936

Provider Business Practice Location Address
First Line	:	640 PHILLIPS AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612
Country	:	US
Telephone Number	:	419-476-7442
Fax Number	:	419-476-9936

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DONALD J KISH
Credential	:
Telephone Number	:	419-476-7442

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	03/31/2015

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Directions to “BROOKESIDE AMBULANCE SERVICE INC ” Practice Location

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