Provider Demographics
NPI:1891879573
Name:MATAMORAS EMERGENCY SQUAD
Entity Type:Organization
Organization Name:MATAMORAS EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SQUAD CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-865-2904
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:NEW MATAMORAS
Mailing Address - State:OH
Mailing Address - Zip Code:45767-0114
Mailing Address - Country:US
Mailing Address - Phone:740-865-2904
Mailing Address - Fax:
Practice Address - Street 1:800 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:NEW MATAMORAS
Practice Address - State:OH
Practice Address - Zip Code:45767-1111
Practice Address - Country:US
Practice Address - Phone:740-865-2904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331948Medicaid
OH0331948Medicaid