Provider Demographics
NPI:1194715797
Name:CRITICAL CARE AMBULANCE SERVICE, LLC
Entity type:Organization
Organization Name:CRITICAL CARE AMBULANCE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:330-242-3092
Mailing Address - Street 1:1181 RIVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9750
Mailing Address - Country:US
Mailing Address - Phone:330-278-2027
Mailing Address - Fax:
Practice Address - Street 1:775 W SMITH RD STE 2
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3556
Practice Address - Country:US
Practice Address - Phone:330-725-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2626439Medicaid
OH9358821Medicare ID - Type UnspecifiedPALMETTO GBA