Healthcare Provider Details

I. General information

NPI: 1144225772
Provider Name (Legal Business Name): MID-OHIO AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S COLUMBUS ST
LANCASTER OH
43130
US

IV. Provider business mailing address

PO BOX 985
LANCASTER OH
43130
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-6100
  • Fax: 740-654-6679
Mailing address:
  • Phone: 740-654-6100
  • Fax: 740-654-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number230042
License Number StateOH

VIII. Authorized Official

Name: MELODY A SMITH
Title or Position: VICE PRESIDENT
Credential:
Phone: 740-654-6100