Provider Demographics
NPI:1396826749
Name:BRICKNER AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:BRICKNER AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-2381
Mailing Address - Street 1:419 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1944
Mailing Address - Country:US
Mailing Address - Phone:419-238-2381
Mailing Address - Fax:419-238-2382
Practice Address - Street 1:419 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1944
Practice Address - Country:US
Practice Address - Phone:419-238-2381
Practice Address - Fax:419-238-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8100173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975682Medicaid
OH9012821Medicare PIN