Provider Demographics
NPI:1750462065
Name:CRITICAL CARE TRANSPORT INC.
Entity Type:Organization
Organization Name:CRITICAL CARE TRANSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT P
Authorized Official - Phone:614-775-0564
Mailing Address - Street 1:PO BOX 360912
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43236-0912
Mailing Address - Country:US
Mailing Address - Phone:614-775-0564
Mailing Address - Fax:614-775-0422
Practice Address - Street 1:2936 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2304
Practice Address - Country:US
Practice Address - Phone:614-775-0421
Practice Address - Fax:614-775-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2540333416A0800X
OH2502023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2204528Medicaid
OHCR9312321Medicare PIN