Provider Demographics
NPI:1538374814
Name:1ST ADVANCED TRANSPORTATION LLC
Entity type:Organization
Organization Name:1ST ADVANCED TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMKHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-348-9991
Mailing Address - Street 1:555 OFFICENTER PL
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5314
Mailing Address - Country:US
Mailing Address - Phone:614-348-9991
Mailing Address - Fax:614-418-7085
Practice Address - Street 1:723 NORTH JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-348-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2500123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570516Medicaid