Provider Demographics
NPI:1689603953
Name:CITY OF CRESTLINE
Entity Type:Organization
Organization Name:CITY OF CRESTLINE
Other - Org Name:CRESTLINE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-683-3625
Mailing Address - Street 1:100 N SELTZER ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1803
Mailing Address - Country:US
Mailing Address - Phone:419-683-3800
Mailing Address - Fax:
Practice Address - Street 1:100 N SELTZER ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1803
Practice Address - Country:US
Practice Address - Phone:419-683-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590175303OtherRR MEDICARE
OH0219696Medicaid
OH000000224325OtherANTHEM
OH0015751OtherTRICARE
OH0219696Medicaid