Provider Demographics
NPI:1063604122
Name:P.S.C. TRANSPORTATION INCORPORATED
Entity type:Organization
Organization Name:P.S.C. TRANSPORTATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:OZUEM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:216-378-2911
Mailing Address - Street 1:4421 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5754
Mailing Address - Country:US
Mailing Address - Phone:440-804-4382
Mailing Address - Fax:216-378-2913
Practice Address - Street 1:4421 RENAISSANCE PKWY
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5754
Practice Address - Country:US
Practice Address - Phone:440-804-4382
Practice Address - Fax:216-378-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187175343800000X
OH180695343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH302949Medicaid