MEDICARE: FAZARI TRANSPORTATION LIMITED

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	343800000X	Secured Medical Transport (VAN)		OH

General Provider Information

NPI Number	:	1548623895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAZARI TRANSPORTATION LIMITED

Provider Business Mailing Address
First Line	:	17705 LAKE SHORE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-2635
Country	:	US
Telephone Number	:	216-338-9315
Fax Number	:	216-481-8122

Provider Business Practice Location Address
First Line	:	17705 LAKE SHORE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-2635
Country	:	US
Telephone Number	:	216-338-9315
Fax Number	:	216-481-8122

Authorized Official
Title or Position	:	OWNER
Name	:	MR. THADDEUS ROBERT WAGABA
Credential	:
Telephone Number	:	216-338-9315

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/04/2016

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