Provider Demographics
NPI:1316267297
Name:OHIO MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:OHIO MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-877-1235
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-0307
Mailing Address - Country:US
Mailing Address - Phone:937-877-1235
Mailing Address - Fax:937-387-9370
Practice Address - Street 1:2740 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-1108
Practice Address - Country:US
Practice Address - Phone:937-877-1235
Practice Address - Fax:937-387-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061966Medicaid
H036610Medicare PIN