Provider Demographics
NPI:1144932773
Name:RUSS, TRENT TIMOTHY
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:TIMOTHY
Last Name:RUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 ALMYRA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3101
Mailing Address - Country:US
Mailing Address - Phone:330-518-3203
Mailing Address - Fax:330-782-7858
Practice Address - Street 1:493 ALMYRA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3101
Practice Address - Country:US
Practice Address - Phone:330-518-3203
Practice Address - Fax:330-782-7858
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)