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General NPI Number Information
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NPI Number | 1154648129
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Entity Type | Organization
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Legal Business Name | TAND C AMBULANCE SERVICE LLC
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 40 MICKEY RD
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City | SHELBY
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State | OH
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Zip | 44875-1737
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Country | US
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Telephone | 419-544-1076
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 HEMPSTEAD STATION DR
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City | KETTERING
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State | OH
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Zip | 45429-5164
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Country | US
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Telephone | 800-875-0136
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BONNIE L WILSON
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Credential |
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Telephone | 419-342-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1910375
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License Number State | OH
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