Provider Demographics
NPI:1710060629
Name:AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:AMBULANCE SERVICE, INC.
Other - Org Name:STEUBENVILLE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERCEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-283-3681
Mailing Address - Street 1:1439 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1521
Mailing Address - Country:US
Mailing Address - Phone:740-283-3681
Mailing Address - Fax:740-264-9811
Practice Address - Street 1:1439 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1521
Practice Address - Country:US
Practice Address - Phone:740-283-3681
Practice Address - Fax:740-282-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4100123416L0300X
OH415015343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0153935Medicaid
WV0145948000Medicaid
WV0145948000Medicaid