Healthcare Provider Details

I. General information

NPI: 1407978539
Provider Name (Legal Business Name): BOLAND MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 EAST 170TH STREET
CLEVELAND OH
44110
US

IV. Provider business mailing address

1221 EAST 170TH STREET
CLEVELAND OH
44110
US

V. Phone/Fax

Practice location:
  • Phone: 216-599-0238
  • Fax: 216-383-9683
Mailing address:
  • Phone: 216-599-0238
  • Fax: 216-383-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ADENIYI S MOGAJI
Title or Position: PRESIDENT
Credential:
Phone: 216-559-0238