Provider Demographics
NPI:1467452714
Name:J&C AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:J&C AMBULANCE SERVICE, INC.
Other - Org Name:LIFECARE MEDICAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-899-0022
Mailing Address - Street 1:7100 WHIPPLE AVENUE NW
Mailing Address - Street 2:SUITE G
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7167
Mailing Address - Country:US
Mailing Address - Phone:330-899-0022
Mailing Address - Fax:330-484-2932
Practice Address - Street 1:7100 WHIPPLE AVENUE NW
Practice Address - Street 2:SUITE G
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7167
Practice Address - Country:US
Practice Address - Phone:330-899-0022
Practice Address - Fax:330-484-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7600823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2209658Medicaid
OH2286048Medicaid
OH2319708Medicaid
OH2403698Medicaid
OH080039100OtherFEDERAL BLACK LUNG
OH000000195082OtherANTHEM
OH2169540Medicaid
OH128375200OtherUS DEPARTMENT OF LABOR
OH2169577Medicaid
OH2319708Medicaid
OH9310632Medicare PIN
OH9331491Medicare PIN
OH9306641Medicare PIN
OH2209658Medicaid
OH2169577Medicaid
OH590014809Medicare PIN