Provider Demographics
NPI:1760188791
Name:SUBER, ROBERT ANTWAIN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTWAIN
Last Name:SUBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BILLIE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1404
Mailing Address - Country:US
Mailing Address - Phone:614-625-0530
Mailing Address - Fax:
Practice Address - Street 1:1125 BILLIE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1404
Practice Address - Country:US
Practice Address - Phone:614-625-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT479714343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)