Healthcare Provider Details

I. General information

NPI: 1710086723
Provider Name (Legal Business Name): CARLSON AMBULANCE TRANSPORT SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 PEARL RD
BRUNSWICK OH
44212-3406
US

IV. Provider business mailing address

1642 PEARL RD
BRUNSWICK OH
44212-3406
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-2400
  • Fax: 330-225-6486
Mailing address:
  • Phone: 330-225-2400
  • Fax: 330-225-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number520032
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number525015
License Number StateOH

VIII. Authorized Official

Name: PATRICK E CARLSON
Title or Position: PRESIDENT
Credential: FUNERAL DIRECTOR
Phone: 330-225-2400