Provider Demographics
NPI:1861453599
Name:FIRELANDS AMBULANCE SERVICE
Entity Type:Organization
Organization Name:FIRELANDS AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:419-929-1487
Mailing Address - Street 1:25 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1211
Mailing Address - Country:US
Mailing Address - Phone:419-929-1487
Mailing Address - Fax:
Practice Address - Street 1:25 JAMES ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-1211
Practice Address - Country:US
Practice Address - Phone:419-929-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155453OtherANTHEM INSURANCE
OH0392347Medicaid
OH0392347Medicaid