Provider Demographics
NPI:1750432381
Name:SOUTH LORAIN COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:SOUTH LORAIN COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOXEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-647-5803
Mailing Address - Street 1:179 E HERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-1302
Mailing Address - Country:US
Mailing Address - Phone:440-647-5803
Mailing Address - Fax:440-647-4252
Practice Address - Street 1:179 E HERRICK AVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-1302
Practice Address - Country:US
Practice Address - Phone:440-647-5803
Practice Address - Fax:440-647-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0420300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0453683Medicaid
OH792590162OtherRR MEDICARE
OH000000155432OtherBCBS
OH0453683Medicaid
OH=========-002OtherMEDMUTUAL
OH9152231Medicare PIN