Healthcare Provider Details

I. General information

NPI: 1063600799
Provider Name (Legal Business Name): SMITH AMBULANCE OF STARK-SUMMIT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W 3RD ST
DOVER OH
44622-2965
US

IV. Provider business mailing address

1310 ERIE STREET SOUTH
MASSILLON OH
44646-5545
US

V. Phone/Fax

Practice location:
  • Phone: 330-602-5180
  • Fax: 330-602-5471
Mailing address:
  • Phone: 330-837-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021762803
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021762802
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021762801
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021762806
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021762800
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT L SMITH
Title or Position: PRESIDENT
Credential:
Phone: 330-602-4718