Provider Demographics
NPI:1003989716
Name:JOINT EMERGENCY MEDICAL SERVICE BERGHOLZ EMS
Entity Type:Organization
Organization Name:JOINT EMERGENCY MEDICAL SERVICE BERGHOLZ EMS
Other - Org Name:BERGHOLZ EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALIANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-768-2151
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:BERGHOLZ
Mailing Address - State:OH
Mailing Address - Zip Code:43908-0328
Mailing Address - Country:US
Mailing Address - Phone:740-768-2151
Mailing Address - Fax:
Practice Address - Street 1:385 THIRD STREET
Practice Address - Street 2:
Practice Address - City:BERGHOLZ
Practice Address - State:OH
Practice Address - Zip Code:43908-0328
Practice Address - Country:US
Practice Address - Phone:740-768-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0980800341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000225691OtherBCBS
OH2992810Medicaid
OH590013413OtherRRMEDICARE
OH2992810Medicaid
OH590013413OtherRRMEDICARE