Healthcare Provider Details

I. General information

NPI: 1366568636
Provider Name (Legal Business Name): MVM MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25000 EUCLID AVE STE 205
EUCLID OH
44117-2647
US

IV. Provider business mailing address

25000 EUCLID AVE STE 205
EUCLID OH
44117-2647
US

V. Phone/Fax

Practice location:
  • Phone: 216-732-9569
  • Fax:
Mailing address:
  • Phone: 216-732-9569
  • Fax: 216-732-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BONITA DURHAM
Title or Position: OWNER
Credential:
Phone: 216-732-9565