Healthcare Provider Details

I. General information

NPI: 1700167301
Provider Name (Legal Business Name): PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S WEST ST
PIKETON OH
45661-9549
US

IV. Provider business mailing address

2796 GALLIA ST
PORTSMOUTH OH
45662-4807
US

V. Phone/Fax

Practice location:
  • Phone: 740-289-2932
  • Fax:
Mailing address:
  • Phone: 740-354-3122
  • Fax: 740-353-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number73-0472
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number73-0472
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number73-0472
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL L ADKINS
Title or Position: CEO
Credential:
Phone: 740-354-3122