MEDICARE: PRIME MEDICAL TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1699613869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	3503 HUNTING BROOK DR APT 301
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4938
Country	:	US
Telephone Number	:	380-206-4656
Fax Number	:	380-206-4656

Provider Business Practice Location Address
First Line	:	3503 HUNTING BROOK DR APT 301
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4938
Country	:	US
Telephone Number	:	380-206-4656
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MERIH BERHANE WOLDEAB
Credential	:	WOLDEAB
Telephone Number	:	380-206-4656

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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