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)		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2788470	OTHER	OH	PASSPORT

General Provider Information

NPI Number	:	1457524340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPORT INC

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

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JAMES J REINHOLZ JR.
Credential	:
Telephone Number	:	216-587-9715

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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Directions to “MEDPORT INC ” Practice Location

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