MEDICARE: MEDICARE 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	343900000X	Non-emergency Medical Transport (VAN)	1812480	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2907AFH	OTHER	OH	OHIO DEPARTMENT OF MENTAL HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1812480	OTHER	OH	OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES

General Provider Information

NPI Number	:	1003252537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICARE TRANSPORT INC

Provider Business Mailing Address
First Line	:	6100 OAK TREE BLVD
Second Line	:	SUITE 200
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2544
Country	:	US
Telephone Number	:	877-706-4407
Fax Number	:	216-370-3245

Provider Business Practice Location Address
First Line	:	6100 OAK TREE BLVD
Second Line	:	SUITE 200
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2544
Country	:	US
Telephone Number	:	877-706-4407
Fax Number	:	216-370-3245

Authorized Official
Title or Position	:	CEO
Name	:	TANYA CARGILL
Credential	:
Telephone Number	:	877-706-4407

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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