Healthcare Provider Details

I. General information

NPI: 1528325255
Provider Name (Legal Business Name): EMS TEAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HANGAR DR
VANDALIA OH
45377-1056
US

IV. Provider business mailing address

PO BOX 189
VANDALIA OH
45377-0189
US

V. Phone/Fax

Practice location:
  • Phone: 937-877-1235
  • Fax:
Mailing address:
  • Phone: 937-877-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number570122
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DERECK M PRISTAS
Title or Position: PRESIDENT
Credential:
Phone: 937-877-1235