Provider Demographics
NPI:1093715153
Name:JOHNSON-ST. PARIS EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:JOHNSON-ST. PARIS EMERGENCY MEDICAL SERVICE
Other - Org Name:JOHNSON-ST.PARIS EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS BILLING CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:SUELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-663-4955
Mailing Address - Street 1:PO BOX 750430
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-0430
Mailing Address - Country:US
Mailing Address - Phone:937-291-7850
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:137 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ST. PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072
Practice Address - Country:US
Practice Address - Phone:937-663-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0364298Medicaid
OH000000262550OtherANTHEM
OH0364298Medicaid