Provider Demographics
NPI:1457056277
Name:PAGE, STEPHEN (NONMEDICALTRANSPORT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:NONMEDICALTRANSPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 ZIMMERMAN LN
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1074
Mailing Address - Country:US
Mailing Address - Phone:419-525-2512
Mailing Address - Fax:
Practice Address - Street 1:3610 ZIMMERMAN LN
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1074
Practice Address - Country:US
Practice Address - Phone:419-525-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH92-0961538343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)