Provider Demographics
NPI:1023517927
Name:QUEEN CITY MEDICAL TRANSPORT
Entity type:Organization
Organization Name:QUEEN CITY MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:FORESTINE
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-903-4073
Mailing Address - Street 1:824 W. NORTH BEND
Mailing Address - Street 2:UNIT 2 BOX #5
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224
Mailing Address - Country:US
Mailing Address - Phone:513-903-4073
Mailing Address - Fax:513-672-2009
Practice Address - Street 1:824 W. NORTH BEND
Practice Address - Street 2:UNIT 2 BOX #5
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224
Practice Address - Country:US
Practice Address - Phone:513-903-4073
Practice Address - Fax:513-672-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
OH0240566343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240566Medicaid