Provider Demographics
NPI:1598308298
Name:PREMIER OHIO TRANSPORTATION IN
Entity Type:Organization
Organization Name:PREMIER OHIO TRANSPORTATION IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DELONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-410-4751
Mailing Address - Street 1:17325 EUCLID AVE STE 3029
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1255
Mailing Address - Country:US
Mailing Address - Phone:216-410-4751
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 3029
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1255
Practice Address - Country:US
Practice Address - Phone:216-410-4751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)