1750462065 NPI number — CRITICAL CARE TRANSPORT INC.

Table of content: (NPI 1750462065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750462065 NPI number — CRITICAL CARE TRANSPORT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRITICAL CARE TRANSPORT INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750462065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360912
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43236-0912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-775-0564
Provider Business Mailing Address Fax Number:
614-775-0422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2936 E 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43219-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-775-0421
Provider Business Practice Location Address Fax Number:
614-775-0422
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STANTON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
614-775-0564

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  254033 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 250202 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2204528 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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