Active NPI
Connie Scarbrough
- Land Ambulance
- Fulton, OH
National Provider Identifier
1992851638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- CONNIE SCARBROUGH
- Practice address
- 200 Center Street
Fulton, OH 43321 - Phone
- (419) 864-3957
- Fax
- (419) 864-3967
- NPI assigned
- Jan 26, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Connie Scarbrough
- Title
- Owner
- Phone
- (419) 768-4000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | OH | Primary |
Addresses
Primary practice location
200 Center Street
Fulton, OH 43321
Mailing address
200 Center Street PO Box 97
Fulton, OH 43321
Phone (419) 864-3957
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0213941 | Medicaid | OH |
Other names 1
- Life Line Medical Ambulance
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031208001098 | OH | Part B Supplier - Ambulance Service Supplier | 0941106314 | Practice locations: Fulton, OH |
National Provider Directory
National Provider Directory- Tax ID family
- Connie Scarbrough
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulance
- Fulton, OH
- NPI 1043288624
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731888000000",
"number": "1992851638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 CENTER STREET PO BOX 97",
"city": "FULTON",
"state": "OH",
"postal_code": "43321",
"telephone_number": "419-864-3957",
"fax_number": "419-864-3967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 CENTER STREET",
"city": "FULTON",
"state": "OH",
"postal_code": "43321",
"telephone_number": "419-864-3957",
"fax_number": "419-864-3967"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONNIE SCARBROUGH",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-26",
"last_updated": "2024-11-18",
"status": "A",
"authorized_official_last_name": "SCARBROUGH",
"authorized_official_first_name": "CONNIE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "419-768-4000",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0213941",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Life Line Medical Ambulance",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fulton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.