PC on Board, LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

MTB-1051 Issued in OH

Legal business name

PC ON BOARD, LLC

Doing business as

Hart's Ambulette

Practice address

3134 E State St
Fremont, OH 43420-9280

Phone

(419) 332-3911

Fax

(419) 332-3820

NPI assigned

Mar 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Laurey C Medvick-Tate

Title

Owner

Phone

(419) 332-3911

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• HART'S AMBULETTE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1093776775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3134 E STATE ST",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434209280",
            "telephone_number": "419-332-3911",
            "fax_number": "419-332-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3134 E STATE ST",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434209280",
            "telephone_number": "419-332-3911",
            "fax_number": "419-332-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PC ON BOARD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "MEDVICK-TATE",
        "authorized_official_first_name": "LAUREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-332-3911",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "OH",
            "license": "MTB-1051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "61101",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKYE COMMUNITY HEALTH",
            "identifier": "734548",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2549871",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HART'S AMBULETTE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olivia Judith Paul
• James Paulus, QMHS
• Pamela A Pavlis
• Christy Pawlikowski, NP-C
• Catherine Ann Pawsey
• Maya Sharia Peacock, LPN
• Terese Peters, LPTA
• Andrew A Peterson, D.D.S.
• Pharmacy Counter LLC
• Sandra Phillips

• Non-emergency Medical Transport (VAN) in Fremont, OH
• Providers in Fremont, OH by specialty
• Non-emergency Medical Transport (VAN) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.