Provider Demographics
NPI:1871755769
Name:TRI-STATE AMBULANCE SERVICE, LLC
Entity type:Organization
Organization Name:TRI-STATE AMBULANCE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF BOARD
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-324-0016
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2438
Mailing Address - Country:US
Mailing Address - Phone:606-465-7373
Mailing Address - Fax:
Practice Address - Street 1:1536 WINCHESTER AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7662
Practice Address - Country:US
Practice Address - Phone:606-465-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance