=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801989488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMNI TRANSPORT SYSTEMS CHARLESTON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 12/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1580 LEAST TERN LN BUILDING 673
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-746-0948
-----------------------------------------------------
Fax | 843-746-0949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6119
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85216-6119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-760-1583
-----------------------------------------------------
Fax | 480-988-3843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF COMPLIANCE
-----------------------------------------------------
Name | MARNIE REDMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-760-1583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416A0800X
-----------------------------------------------------
Taxonomy Name | Air Ambulance
-----------------------------------------------------
License Number | 171
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------