Provider Demographics
NPI:1316047186
Name:PYMATUNING AMBULANCE SERVICE
Entity type:Organization
Organization Name:PYMATUNING AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-293-7991
Mailing Address - Street 1:153 STATION ST.
Mailing Address - Street 2:P. O. BOX 1509
Mailing Address - City:ANDOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44003
Mailing Address - Country:US
Mailing Address - Phone:440-293-7991
Mailing Address - Fax:440-293-6125
Practice Address - Street 1:153 STATION ST.
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003
Practice Address - Country:US
Practice Address - Phone:440-293-7991
Practice Address - Fax:440-293-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2032811Medicaid
OH2032811Medicaid