Basic Information
| Provider Information | |||||||||
| NPI: | 1285671073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL CARE CONTINUUM SERVICE CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1165 DUBLIN RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432151005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142340300 | ||||||||
| FaxNumber: | 6142340306 | ||||||||
| Practice Location | |||||||||
| Address1: | 1165 DUBLIN RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432151005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142340300 | ||||||||
| FaxNumber: | 6142340306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | PRIMEAU | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 6145464301 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 250079 | OH | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 760485 | 05 | OH | MEDICAID |