Provider Demographics
NPI:1386171064
Name:OMLOR SPECIALIZED TRANSPORT LLC
Entity type:Organization
Organization Name:OMLOR SPECIALIZED TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHLENE
Authorized Official - Last Name:OMLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-204-6790
Mailing Address - Street 1:19301 SANTA FE LINE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45896-9424
Mailing Address - Country:US
Mailing Address - Phone:567-204-6790
Mailing Address - Fax:
Practice Address - Street 1:19301 SANTA FE LINE RD
Practice Address - Street 2:
Practice Address - City:WAYNESFIELD
Practice Address - State:OH
Practice Address - Zip Code:45896-9424
Practice Address - Country:US
Practice Address - Phone:567-204-6790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRM419467343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)