Provider Demographics
NPI:1598989378
Name:PORTSMOUTH AMBULANCE INC
Entity Type:Organization
Organization Name:PORTSMOUTH AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-465-7373
Mailing Address - Street 1:PO BOX 1860
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1860
Mailing Address - Country:US
Mailing Address - Phone:740-353-7553
Mailing Address - Fax:
Practice Address - Street 1:1536 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7662
Practice Address - Country:US
Practice Address - Phone:740-353-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7301023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0780212Medicaid
59014451OtherRAILROAD MEDICARE
KY55000285Medicaid
KY56017007Medicaid
OH000000186402OtherBLUE CROSS
KY8049001Medicare PIN
OH9313671Medicare PIN