Healthcare Provider Details

I. General information

NPI: 1659384006
Provider Name (Legal Business Name): MOBIL MARTIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 W 73RD ST
CLEVELAND OH
44102-2060
US

IV. Provider business mailing address

14837 DETROIT AVE BOX 123
LAKEWOOD OH
44107-3909
US

V. Phone/Fax

Practice location:
  • Phone: 216-281-9300
  • Fax: 216-281-8500
Mailing address:
  • Phone: 216-281-9300
  • Fax: 216-281-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number180322
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number185815
License Number StateOH

VIII. Authorized Official

Name: MR. MARTIN O VIRSIS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 216-281-7777