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General NPI Number Information
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NPI Number | 1861785677
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Entity Type | Organization
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Legal Business Name | MARIETTA AMBULANCE SERVICE LTD
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 101 PUTNAM ST
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City | MARIETTA
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State | OH
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Zip | 45750-2924
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Country | US
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Telephone | 740-373-1494
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Fax |
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Provider Business Mailing Address
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Address Line | 836 4TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-1407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROGER ANDERSON
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Credential |
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Telephone | 740-373-1494
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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 | 840042
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License Number State | OH
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