Provider Demographics
NPI:1376509612
Name:ADVANCED AMBULANCE LLC
Entity Type:Organization
Organization Name:ADVANCED AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:H
Authorized Official - Last Name:GATES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:440-230-5339
Mailing Address - Street 1:1026 PEARL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:440-230-5339
Mailing Address - Fax:440-230-5329
Practice Address - Street 1:8641 W 130TH ST
Practice Address - Street 2:
Practice Address - City:N ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133
Practice Address - Country:US
Practice Address - Phone:440-230-5339
Practice Address - Fax:440-230-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2097645Medicaid
OH9301671Medicare ID - Type Unspecified