Provider Demographics
NPI:1780918672
Name:ALLIED AMBULANCE SERVICES LLC
Entity type:Organization
Organization Name:ALLIED AMBULANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-205-6926
Mailing Address - Street 1:9927 STATE ROUTE 774
Mailing Address - Street 2:
Mailing Address - City:HAMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45130-8774
Mailing Address - Country:US
Mailing Address - Phone:937-379-1404
Mailing Address - Fax:937-379-1579
Practice Address - Street 1:9927 STATE ROUTE 774
Practice Address - Street 2:
Practice Address - City:HAMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45130-8774
Practice Address - Country:US
Practice Address - Phone:937-379-1404
Practice Address - Fax:937-379-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000644856OtherANTHEM SENIOR ADVANTAGE
OH000000644856OtherANTHEM BC/BS
OH3045029Medicaid
P00799545Medicare PIN
OH000000644856OtherANTHEM BC/BS