Provider Demographics
NPI:1710086723
Name:CARLSON AMBULANCE TRANSPORT SERVICE, INC.
Entity Type:Organization
Organization Name:CARLSON AMBULANCE TRANSPORT SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:FUNERAL DIRECTOR
Authorized Official - Phone:330-225-2400
Mailing Address - Street 1:1642 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3406
Mailing Address - Country:US
Mailing Address - Phone:330-225-2400
Mailing Address - Fax:330-225-6486
Practice Address - Street 1:1642 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3406
Practice Address - Country:US
Practice Address - Phone:330-225-2400
Practice Address - Fax:330-225-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH520032341600000X
OH525015343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1314429Medicaid
OH9022241Medicare ID - Type UnspecifiedMEDICARE NUMBER
OH1314429Medicaid