Provider Demographics
NPI:1548350572
Name:AMERICAN AMBULETTE & AMBULANCE SERVICE, INC
Entity type:Organization
Organization Name:AMERICAN AMBULETTE & AMBULANCE SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:A
Authorized Official - Last Name:URBANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-727-0544
Mailing Address - Street 1:2107 JERGENS RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1227
Mailing Address - Country:US
Mailing Address - Phone:419-727-0544
Mailing Address - Fax:419-727-0539
Practice Address - Street 1:729 6TH STREET
Practice Address - Street 2:D/B/A LIFE
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-354-6169
Practice Address - Fax:937-237-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16763416A0800X
OH5700923416L0300X
KY1271343900000X
KY16573416S0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416S0300XTransportation ServicesAmbulanceWater Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0429129Medicaid
OH9173374Medicare ID - Type Unspecified