=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487092862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2013
-----------------------------------------------------
Last Update Date | 06/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 186 HAUSER AVE
-----------------------------------------------------
City | SOUTH SHORE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-354-3122
-----------------------------------------------------
Fax | 740-351-0679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2796 GALLIA STREET
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-354-3122
-----------------------------------------------------
Fax | 740-351-0679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | RACHAEL ESTEP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-354-3122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 1676 / 1677
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 1676
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1677
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 1677
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1676
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------