Healthcare Provider Details

I. General information

NPI: 1861612368
Provider Name (Legal Business Name): MIRACLE MEDICAL TRANSPORTATION,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655-A N. GREENWAY CT
HIGHLAND HTS OH
44143
US

IV. Provider business mailing address

6700 BETA DR SUITE #118
MAYFIELD VILLAGE OH
44143
US

V. Phone/Fax

Practice location:
  • Phone: 440-336-1646
  • Fax: 440-229-5010
Mailing address:
  • Phone: 440-336-1646
  • Fax: 440-229-5010

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: FAINA UCHITEL
Title or Position: PRESIDENT
Credential:
Phone: 440-336-1646