Provider Demographics
NPI:1104872142
Name:EMERGENCY MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:EMERGENCY MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PARAMEDIC
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:330-484-8894
Mailing Address - Street 1:7100 WHIPPLE AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7167
Mailing Address - Country:US
Mailing Address - Phone:330-484-8894
Mailing Address - Fax:330-484-2932
Practice Address - Street 1:7100 WHIPPLE AVE NW STE A
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7167
Practice Address - Country:US
Practice Address - Phone:330-478-4111
Practice Address - Fax:330-232-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0211035503416A0800X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8001026000Medicaid
OH2000051Medicaid
OH000000155881OtherBCBS
OH00023436OtherMT.STATE
OH3481838901OtherBWC
OH590010656OtherRR MEDICARE
OH800024OtherBLACKLUNG
OH00023436OtherMT.STATE
OH2000051Medicaid
9285903Medicare PIN
OH3481838901OtherBWC