MEDICARE: EASTERN AREA SPECIALTY TRANSPORT, INC.

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	341600000X	Ambulance	02-1229650	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326091760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN AREA SPECIALTY TRANSPORT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:	1000 INDUSTRIAL DRIVE
City	:	LEESBURG
State	:	OH
Zip	:	45135-0368
Country	:	US
Telephone Number	:	937-780-6520
Fax Number	:	937-780-6758

Provider Business Practice Location Address
First Line	:	1000 INDUSTRIAL DRIVE
Second Line	:
City	:	LEESBURG
State	:	OH
Zip	:	45135
Country	:	US
Telephone Number	:	937-780-6520
Fax Number	:	937-780-6758

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVE HAINES
Credential	:
Telephone Number	:	937-780-6520

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/12/2009

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