MEDICARE: CRITICAL CARE TRANSPORT INC.

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	3416A0800X	Air Ambulance	254033	OH
2	3416L0300X	Land Ambulance	250202	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750462065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRITICAL CARE TRANSPORT INC.

Provider Business Mailing Address
First Line	:	PO BOX 360912
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43236-0912
Country	:	US
Telephone Number	:	614-775-0564
Fax Number	:	614-775-0422

Provider Business Practice Location Address
First Line	:	2936 E 14TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2304
Country	:	US
Telephone Number	:	614-775-0421
Fax Number	:	614-775-0422

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILLIAM L. STANTON
Credential	:	EMT P.
Telephone Number	:	614-775-0564

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/24/2013

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Directions to “CRITICAL CARE TRANSPORT INC. ” Practice Location

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