Provider Demographics
NPI:1356816680
Name:SOUTH WESTERN AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:SOUTH WESTERN AMBULANCE SERVICE LLC
Other - Org Name:AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-348-2852
Mailing Address - Street 1:6161 BUSCH BLVD SUIT 84
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224
Mailing Address - Country:US
Mailing Address - Phone:614-348-2852
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 84
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2548
Practice Address - Country:US
Practice Address - Phone:614-348-2852
Practice Address - Fax:866-390-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-13
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0Medicaid