ENTITY CORPORATION PARTNERSHIP SOLE PROPRIETORSHIP / FORD / Emergency Medical Services / / /
Organization
F.C.C. / COUNTY STATE COUNTY STATE COUNTY STATE COUNTY STATE CHECK TYPE OF ORGANIZATION PRIVATE AMBULANCE FUNERAL HOME AMBULANCE CORPORATION PUBLIC SERVICE / Emergency Medical Service / Ohio Department of Public Safety Division of Emergency Medical Services / MEDICARE / / /
Position
Executive Officer / EMS Service Code Field Inspector Assigned NAME Reviewed Field Inspector / MEDICAL DIRECTOR PHYSICIAN / CHIEF / EXECUTIVE OFFICER / CHIEF / CEO / /
OHIO DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MEDICAL SERVICES APPLICATION FOR AMBULANCE OR MOBILE INTENSIVE CARE LICENSE