=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154457166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLESEED JOINT AMBULANCE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 11/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 MAIN ST N
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45814-0678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-365-5853
-----------------------------------------------------
Fax | 419-365-1286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 N MAIN STREET P O BOX 678
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45814-0678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-365-5853
-----------------------------------------------------
Fax | 419-365-1286
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLERK
-----------------------------------------------------
Name | BETHANY R DRISKILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-365-5853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------