Provider Demographics
NPI:1467459909
Name:TRI-COUNTY AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:TRI-COUNTY AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-951-4600
Mailing Address - Street 1:7000 SPINACH DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4958
Mailing Address - Country:US
Mailing Address - Phone:440-951-4600
Mailing Address - Fax:440-974-9202
Practice Address - Street 1:7000 SPINACH DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4958
Practice Address - Country:US
Practice Address - Phone:440-951-4600
Practice Address - Fax:440-974-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4300923416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155614OtherANTHEM
OH0596725Medicaid
OH81-00108OtherEVERCARE
OH=========001OtherMMO
OH81-00108OtherEVERCARE
OH0596725Medicaid
OH0596725Medicaid