Provider Demographics
NPI:1225357163
Name:OMNI TRANSPORT LLC
Entity Type:Organization
Organization Name:OMNI TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DERON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:513-591-3900
Mailing Address - Street 1:611 SHEPHERD DR STE 14&15
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2146
Mailing Address - Country:US
Mailing Address - Phone:513-591-3900
Mailing Address - Fax:187-744-4692
Practice Address - Street 1:611 SHEPHERD DR STE 14&15
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2146
Practice Address - Country:US
Practice Address - Phone:513-591-3900
Practice Address - Fax:187-744-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9390191Medicare PIN