Provider Demographics
NPI:1174844294
Name:U1ST MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:U1ST MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAWANZA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1614-559-0616
Mailing Address - Street 1:1028 LORNABERRY LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3328
Mailing Address - Country:US
Mailing Address - Phone:614-559-0616
Mailing Address - Fax:614-866-2971
Practice Address - Street 1:1028 LORNABERRY LN
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3328
Practice Address - Country:US
Practice Address - Phone:614-559-0616
Practice Address - Fax:614-866-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3041023343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041023Medicaid