MEDICARE: ELITE AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1184063695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:
City	:	OWENSVILLE
State	:	OH
Zip	:	45160-0308
Country	:	US
Telephone Number	:	888-222-1356
Fax Number	:	888-222-1356

Provider Business Practice Location Address
First Line	:	308 WEST MAIN STREET
Second Line	:
City	:	OWENSVILLE
State	:	OH
Zip	:	45160
Country	:	US
Telephone Number	:	513-735-1192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MR. JEREMY LEE WOODWARD
Credential	:	EMT
Telephone Number	:	888-222-1356

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	09/22/2014

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