Healthcare Provider Details

I. General information

NPI: 1154922607
Provider Name (Legal Business Name): RV PROVIDER AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4497 MARTIN LUTHER KING JR BLVD
GARFIELD HEIGHTS OH
44105-6947
US

IV. Provider business mailing address

4497 MARTIN LUTHER KING JR BLVD
GARFIELD HEIGHTS OH
44105-6947
US

V. Phone/Fax

Practice location:
  • Phone: 216-355-1306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: RUTH LOWE-GIBSON
Title or Position: OWNER
Credential:
Phone: 216-355-1306