Provider Demographics
NPI:1487092862
Name:PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-3122
Mailing Address - Street 1:2796 GALLIA STREET
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-354-3122
Mailing Address - Fax:740-351-0679
Practice Address - Street 1:186 HAUSER AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175
Practice Address - Country:US
Practice Address - Phone:740-354-3122
Practice Address - Fax:740-351-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1676 / 1677341600000X
3416L0300X, 343900000X
KY1676343900000X, 3416L0300X
KY16773416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096759Medicaid
KY1487092862OtherKY MEDICARE PROVIDER NUMBER K093870
KY7100189640Medicaid
KY7100260300Medicaid
OH3159442Medicaid
KY7100174460Medicaid
KY7100260270Medicaid
OH96759Medicaid
OH0096759Medicaid