Healthcare Provider Details

I. General information

NPI: 1316047186
Provider Name (Legal Business Name): PYMATUNING AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 STATION ST.
ANDOVER OH
44003
US

IV. Provider business mailing address

153 STATION ST. P. O. BOX 1509
ANDOVER OH
44003
US

V. Phone/Fax

Practice location:
  • Phone: 440-293-7991
  • Fax: 440-293-6125
Mailing address:
  • Phone: 440-293-7991
  • Fax: 440-293-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MILLER
Title or Position: ASSISTANT CHIEF/TREASURER
Credential:
Phone: 440-293-7991