Provider Demographics
NPI:1063600799
Name:SMITH AMBULANCE OF STARK-SUMMIT INC
Entity type:Organization
Organization Name:SMITH AMBULANCE OF STARK-SUMMIT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-602-4718
Mailing Address - Street 1:1310 ERIE STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-5545
Mailing Address - Country:US
Mailing Address - Phone:330-837-5748
Mailing Address - Fax:
Practice Address - Street 1:214 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2965
Practice Address - Country:US
Practice Address - Phone:330-602-5180
Practice Address - Fax:330-602-5471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMITH MEDICAL TRANSPORTATION SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021762803341600000X
OH021762802341600000X
OH021762801341600000X
OH021762806341600000X
OH021762800341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH613142100OtherFEDERAL WC
OH000000543783OtherANTHEM BCBS
OH2785035Medicaid
OH613142100OtherFEDERAL WC
OH000000543783OtherANTHEM BCBS
OHP00439476Medicare PIN
OH9371631Medicare PIN