Provider Demographics
NPI:1982668174
Name:COURTESY AMBULANCE, INC.
Entity Type:Organization
Organization Name:COURTESY AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARRETT-DUDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-522-8588
Mailing Address - Street 1:1890 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1134
Mailing Address - Country:US
Mailing Address - Phone:740-522-8588
Mailing Address - Fax:740-522-3031
Practice Address - Street 1:1890 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1134
Practice Address - Country:US
Practice Address - Phone:740-522-8588
Practice Address - Fax:740-522-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4500123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9890010000Medicaid
OH0713860Medicaid
OH0000001550300OtherANTHEM BLUE CROSS BLUE SH
WV9890010000Medicaid