Provider Demographics
NPI:1801989488
Name:OMNI TRANSPORT SYSTEMS CHARLESTON LLC
Entity type:Organization
Organization Name:OMNI TRANSPORT SYSTEMS CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-760-1583
Mailing Address - Street 1:PO BOX 6119
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85216-6119
Mailing Address - Country:US
Mailing Address - Phone:800-760-1583
Mailing Address - Fax:480-988-3843
Practice Address - Street 1:1580 LEAST TERN LN
Practice Address - Street 2:BUILDING 673
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-746-0948
Practice Address - Fax:843-746-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1713416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4206937Medicaid
SCAB0198Medicaid
SCAB0198Medicaid