Provider Demographics
NPI:1700167301
Name:PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Other - Org Name:PEASI
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-3122
Mailing Address - Street 1:2796 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4807
Mailing Address - Country:US
Mailing Address - Phone:740-354-3122
Mailing Address - Fax:740-353-2086
Practice Address - Street 1:703 S WEST ST
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9549
Practice Address - Country:US
Practice Address - Phone:740-289-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH73-0472341600000X, 3416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3159442Medicaid
OHPO9395141Medicare PIN