Provider Demographics
NPI:1023215175
Name:TRI COUNTY AMBULANCE INC.
Entity Type:Organization
Organization Name:TRI COUNTY AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-385-4903
Mailing Address - Street 1:231 WEBBER WAY
Mailing Address - Street 2:P. O. BOX 975
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2506
Mailing Address - Country:US
Mailing Address - Phone:330-385-4903
Mailing Address - Fax:330-385-4187
Practice Address - Street 1:231 WEBBER WAY
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2506
Practice Address - Country:US
Practice Address - Phone:330-385-4903
Practice Address - Fax:330-385-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15-003-23416L0300X
OH15-002-2343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141260Medicaid
WV0145537001Medicaid
WV0145537000Medicaid
WV0145537001Medicaid