=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174544373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMITH AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 10/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 WEST 11TH ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-602-5180
-----------------------------------------------------
Fax | 330-602-5471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 WHIPPLE AVE NW STE K
-----------------------------------------------------
City | NORTH CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44720-7167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-602-5180
-----------------------------------------------------
Fax | 330-484-2932
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | AMY HOCKENBERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-602-5180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------