Provider Demographics
NPI:1912143363
Name:ADVANCED CARE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:ADVANCED CARE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-235-1155
Mailing Address - Street 1:643 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1837
Mailing Address - Country:US
Mailing Address - Phone:614-235-1155
Mailing Address - Fax:614-235-1177
Practice Address - Street 1:643 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1837
Practice Address - Country:US
Practice Address - Phone:614-235-1155
Practice Address - Fax:614-235-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000622186OtherANTHEM
OH2991179Medicaid
OH2991179Medicaid
OH=========OtherCIGNA HEALTHCARE
=========OtherNPPN
OH000000622186OtherANTHEM
OH2991179Medicaid