Provider Demographics
NPI:1598770398
Name:ABLE MEDICAL TRANSPORT OF SOUTHERN OHIO LLC
Entity Type:Organization
Organization Name:ABLE MEDICAL TRANSPORT OF SOUTHERN OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-574-5555
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-0315
Mailing Address - Country:US
Mailing Address - Phone:740-574-5555
Mailing Address - Fax:740-574-2790
Practice Address - Street 1:8046 OHIO RIVER RD STE B
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1689
Practice Address - Country:US
Practice Address - Phone:740-574-5555
Practice Address - Fax:740-574-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7301823416L0300X
OH735135343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2652464Medicaid
OH9359251Medicare PIN