Provider Demographics
NPI:1730635962
Name:CENTRAL LORAIN COUNTY JOINT AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:CENTRAL LORAIN COUNTY JOINT AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEKERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-823-2061
Mailing Address - Street 1:PO BOX 72657
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:440-823-2061
Mailing Address - Fax:330-874-4302
Practice Address - Street 1:200 W LORAIN ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-9628
Practice Address - Country:US
Practice Address - Phone:440-823-2061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021532600341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000001045423OtherANTHEM
OH1730635962OtherMEDICAL MUTUAL
OH=========00OtherBWC
OH1730635962OtherMEDICAL MUTUAL