MEDICARE: EAGLEVILLE JOINT AMBULANCE DISTRICT

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	:	1467281881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLEVILLE JOINT AMBULANCE DISTRICT

Provider Business Mailing Address
First Line	:	4657 EMERSON RD
Second Line	:
City	:	BLOOMDALE
State	:	OH
Zip	:	44817-9769
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3995 EAGLEVILLE RD
Second Line	:
City	:	FOSTORIA
State	:	OH
Zip	:	44830-9743
Country	:	US
Telephone Number	:	419-701-4201
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	MARKIE FRUTH
Credential	:
Telephone Number	:	419-561-8316

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	02/20/2025

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Directions to “EAGLEVILLE JOINT AMBULANCE DISTRICT ” Practice Location

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