Provider Demographics
NPI:1659037596
Name:MAHONEY, AUSTIN THEODORE (EMTACLS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:THEODORE
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:EMTACLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2441
Mailing Address - Country:US
Mailing Address - Phone:614-207-8951
Mailing Address - Fax:
Practice Address - Street 1:1516 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2441
Practice Address - Country:US
Practice Address - Phone:614-207-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH084554146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic