Provider Demographics
NPI:1396885315
Name:MINFORD EMERGENCY AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:MINFORD EMERGENCY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SQUAD CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-820-2190
Mailing Address - Street 1:3846 KENTUCKY TRAIL RD
Mailing Address - Street 2:P. O. BOX 58
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8899
Mailing Address - Country:US
Mailing Address - Phone:740-820-2190
Mailing Address - Fax:740-820-2190
Practice Address - Street 1:8466 STATE ROUTE 335
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653
Practice Address - Country:US
Practice Address - Phone:740-820-3700
Practice Address - Fax:740-820-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH485660341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418833Medicaid
OH2418833Medicaid