Provider Demographics
NPI:1619920030
Name:TRI-DIVISION AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:TRI-DIVISION AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-866-9193
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-0352
Mailing Address - Country:US
Mailing Address - Phone:330-866-9193
Mailing Address - Fax:330-866-1879
Practice Address - Street 1:9333 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST SPARTA
Practice Address - State:OH
Practice Address - Zip Code:44626
Practice Address - Country:US
Practice Address - Phone:330-866-9193
Practice Address - Fax:330-866-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0316200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2717260Medicaid
OH=========00OtherBWC
OH2717260Medicaid
OH=========OtherTRICARE
OH=========002OtherMEDMUTUAL