Provider Demographics
NPI:1265501019
Name:NORTHWEST AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:NORTHWEST AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:GILDONE
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:440-466-4900
Mailing Address - Street 1:1480 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041
Mailing Address - Country:US
Mailing Address - Phone:440-466-4900
Mailing Address - Fax:440-466-9469
Practice Address - Street 1:1480 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041
Practice Address - Country:US
Practice Address - Phone:440-466-4900
Practice Address - Fax:440-466-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0286140Medicaid
OH0286140Medicaid