Provider Demographics
NPI:1316945124
Name:NORTH CENTRAL AMBULANCE DISTRICT
Entity type:Organization
Organization Name:NORTH CENTRAL AMBULANCE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TABETHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-533-5639
Mailing Address - Street 1:836 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:304-521-1576
Mailing Address - Fax:304-521-1576
Practice Address - Street 1:131 EAST MAIN CROSS
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:OH
Practice Address - Zip Code:45321-9998
Practice Address - Country:US
Practice Address - Phone:937-533-5639
Practice Address - Fax:304-521-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0209914503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000008067OtherBCBS OF OH
OH590000069OtherRAILROAD MEDICARE
OH000000008067OtherANTHEM
WV0145838000OtherWV MEDICAID
OH0357975Medicaid
OH0410433Medicaid
IN200361400AMedicaid