Provider Demographics
NPI:1831088558
Name:SLOCUM, ANTWON L JR
Entity type:Individual
Prefix:
First Name:ANTWON
Middle Name:L
Last Name:SLOCUM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 CRANBERRY LN NE APT 174
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-3633
Mailing Address - Country:US
Mailing Address - Phone:234-863-8072
Mailing Address - Fax:
Practice Address - Street 1:1762 CRANBERRY LN NE APT 174
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3633
Practice Address - Country:US
Practice Address - Phone:234-863-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVA456097251E00000X, 347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle