Basic Information
| Provider Information | |||||||||
| NPI: | 1164750451 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATIENT TRANSPORT SERVICES OF COLUMBUS LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | COLUMBUS CONNECTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 EDISON DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451502729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135760262 | ||||||||
| FaxNumber: | 5135760379 | ||||||||
| Practice Location | |||||||||
| Address1: | 2160 SOUTHWEST BLVD | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431231893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142340300 | ||||||||
| FaxNumber: | 6142340311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2009 | ||||||||
| LastUpdateDate: | 05/21/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HERDTNER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE, CFO | ||||||||
| AuthorizedOfficialTelephone: | 5135760262 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 25-044-9 | OH | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 3021125 | 05 | OH | MEDICAID | 590013796 | 01 | MEDICARE RR | OTHER |