Provider Demographics
NPI:1023174851
Name:CITIZENS AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:CITIZENS AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:440-839-2144
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:19 RAILROAD ST
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889
Mailing Address - Country:US
Mailing Address - Phone:440-839-2144
Mailing Address - Fax:440-839-1481
Practice Address - Street 1:19 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889
Practice Address - Country:US
Practice Address - Phone:440-839-2144
Practice Address - Fax:440-839-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9163191OtherMEDICARE
OH0384445Medicaid
KY000000155451OtherANTHEM BCBS
590000907OtherRAILROAD MEDICARE
OH=========OtherMEDICAL MUT