Provider Demographics
NPI:1982179354
Name:STAT MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:STAT MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:S
Authorized Official - Last Name:ACLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-207-8017
Mailing Address - Street 1:950 W LEFFEL LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3538
Mailing Address - Country:US
Mailing Address - Phone:937-207-8017
Mailing Address - Fax:
Practice Address - Street 1:950 W LEFFEL LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-3538
Practice Address - Country:US
Practice Address - Phone:937-207-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0296165Medicaid