MEDICARE: MEDPORT, 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)

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	:	1083823025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPORT, INC

Provider Business Mailing Address
First Line	:	PO BOX 25277
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-0277
Country	:	US
Telephone Number	:	216-587-9715
Fax Number	:	216-662-0052

Provider Business Practice Location Address
First Line	:	9400 MIDWEST AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-2420
Country	:	US
Telephone Number	:	216-587-9715
Fax Number	:	216-662-0052

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAY REINHOLZ
Credential	:
Telephone Number	:	216-587-9715

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/01/2008

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Directions to “MEDPORT, INC ” Practice Location

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