MEDICARE: DIVERSIFIED TRANSPORTATION SERVICES

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)	48-529-5	OH

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	:	1770774911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	7300 INTERNATIONAL DR
Second Line	:
City	:	HOLLAND
State	:	OH
Zip	:	43528-9412
Country	:	US
Telephone Number	:	419-867-2555
Fax Number	:	419-535-6447

Provider Business Practice Location Address
First Line	:	2852 SOUTH AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-1534
Country	:	US
Telephone Number	:	419-535-0000
Fax Number	:	419-535-6447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GHASSAN M SHUNNAR
Credential	:
Telephone Number	:	419-867-2555

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	09/02/2008

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Directions to “DIVERSIFIED TRANSPORTATION SERVICES ” Practice Location

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