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Organization

ADA-LIBERTY JT AMBULANCE DIS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NANCY D BUCHER (FISCAL OFFICER)
(419) 634-7729
Entity
Organization

Contact information

Practice address
530 NORTH GILBERT STREET, ADA, OH 45810
(419) 634-7729
(419) 634-5290
Mailing address
10361 SPARTAN DR, CINCINNATI, OH 45215-1220
(800) 962-1484
(513) 772-4464

Taxonomy

Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
020304150
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000156090
ANTHEM BCBS
OH
05
0265672
OH
01
590175429
RAILROAD MEDICARE
Enumeration date
06/15/2007
Last updated
11/04/2016
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