Provider Demographics
NPI:1154399137
Name:MEDCORP EMS SOUTH LLC
Entity type:Organization
Organization Name:MEDCORP EMS SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-727-7000
Mailing Address - Street 1:745 MEDCORP DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1376
Mailing Address - Country:US
Mailing Address - Phone:419-727-7000
Mailing Address - Fax:419-729-6411
Practice Address - Street 1:745 MEDCORP DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1376
Practice Address - Country:US
Practice Address - Phone:419-727-7000
Practice Address - Fax:419-729-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16763416A0800X
OH4803823416L0300X
KY12713416L0300X
KY16573416S0300X
OHN/A343900000X
KY1677347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2613130Medicaid
KY56031065Medicaid
KY55001382Medicaid
OH9356871Medicare PIN
KY55001382Medicaid
KY56031065Medicaid