Provider Demographics
NPI:1528256856
Name:IBRAHIM Y HALLOWAY
Entity type:Organization
Organization Name:IBRAHIM Y HALLOWAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-747-9744
Mailing Address - Street 1:645 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1837
Mailing Address - Country:US
Mailing Address - Phone:614-747-9744
Mailing Address - Fax:614-352-2887
Practice Address - Street 1:645 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1837
Practice Address - Country:US
Practice Address - Phone:614-747-9744
Practice Address - Fax:614-352-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2511223416L0300X
OH258415343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2763442Medicaid
OH3044002Medicaid