Provider Demographics
NPI:1144225772
Name:MID-OHIO AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:MID-OHIO AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-654-6100
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130
Mailing Address - Country:US
Mailing Address - Phone:740-654-6100
Mailing Address - Fax:740-654-6679
Practice Address - Street 1:655 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-654-6100
Practice Address - Fax:740-654-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
OH2300423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
863028OtherFED BLK LUNG
OH863028OtherFEDERAL BLACK LUNG
AN9322525001OtherCIGNA
OH0325080Medicaid
8187024OtherANTHEM
OH000000155019OtherANTHEM BC/BS
OH0004450573OtherAETNA
OH81-80114OtherUNITED HEALTHCARE
OHAN93225250001OtherCIGNA
OHG217OtherMEDIGOLD
OH071701000008OtherCENTRAL BENEFITS
OH81-87024OtherMAIL HANDLERS INSUR
OH9727OtherCHCS NATIONWIDE INS
0004450573OtherAETNA
8180114OtherUHC
9727OtherNATIONWIDE
OH071701000008OtherCENTRAL BENEFITS
OH863028OtherFEDERAL BLACK LUNG
AN9322525001OtherCIGNA
OH863028OtherFEDERAL BLACK LUNG
OH9727OtherCHCS NATIONWIDE INS