MEDICARE: OHIO RELIABLE TRANSPORTATION, LLC

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

General Provider Information

NPI Number	:	1720581606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO RELIABLE TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	4428 WANDA LANE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1026
Country	:	US
Telephone Number	:	614-446-9867
Fax Number	:

Provider Business Practice Location Address
First Line	:	4428 WANDA LANE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1026
Country	:	US
Telephone Number	:	614-446-9867
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED MUKHTAR SHEICK
Credential	:
Telephone Number	:	614-446-9867

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	03/16/2018

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