Provider Demographics
NPI:1679624480
Name:SOUTHEASTERN HARDIN AMBULANCE DISTRICT
Entity type:Organization
Organization Name:SOUTHEASTERN HARDIN AMBULANCE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-363-2134
Mailing Address - Street 1:P.O. BOX 85
Mailing Address - Street 2:
Mailing Address - City:MT. VICTORY
Mailing Address - State:OH
Mailing Address - Zip Code:43340
Mailing Address - Country:US
Mailing Address - Phone:937-593-9748
Mailing Address - Fax:
Practice Address - Street 1:212 SOUTH WHEELER ST
Practice Address - Street 2:
Practice Address - City:MT. VICTORY
Practice Address - State:OH
Practice Address - Zip Code:43340
Practice Address - Country:US
Practice Address - Phone:937-363-2134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268973Medicaid
OH9275171Medicare ID - Type UnspecifiedAMBULANCE