Provider Demographics
NPI:1598849010
Name:PELLIN EMERGENCY MED SE
Entity Type:Organization
Organization Name:PELLIN EMERGENCY MED SE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:330-533-2288
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:10808 AKRON-CANFIELD RD
Mailing Address - City:ELLSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44416-0060
Mailing Address - Country:US
Mailing Address - Phone:330-533-2288
Mailing Address - Fax:330-533-8467
Practice Address - Street 1:10808 AKRON-CANFIELD RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44416-0000
Practice Address - Country:US
Practice Address - Phone:330-533-2288
Practice Address - Fax:330-533-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH500052341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560183Medicaid
OH0560183Medicaid