Provider Demographics
NPI:1194376277
Name:SML SHUTTLE SERVICE
Entity Type:Organization
Organization Name:SML SHUTTLE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:JEANNINE
Authorized Official - Last Name:LYLES- LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LIVERY, AMBULATORY
Authorized Official - Phone:614-515-3624
Mailing Address - Street 1:1228 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2520
Mailing Address - Country:US
Mailing Address - Phone:614-515-3624
Mailing Address - Fax:
Practice Address - Street 1:1228 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2520
Practice Address - Country:US
Practice Address - Phone:614-515-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)