Organization
CITY OF CRESTLINE
Active
Other names
Crestline Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE E ATHERTON (CHIEF)
(419) 683-3823
Entity
Organization
Contact information
Practice address
100 N SELTZER ST, CRESTLINE, OH 44827-1803
(419) 683-3800
Mailing address
PO BOX 392907, PITTSBURGH, PA 15251-9907
(419) 683-3800
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224325
ANTHEM
OH
01
—
0015751
TRICARE
OH
05
—
0219696
—
OH
01
—
590175303
RR MEDICARE
OH
Enumeration date
06/30/2006
Last updated
10/16/2024
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