Healthcare Provider Details

I. General information

NPI: 1407961501
Provider Name (Legal Business Name): MITCHEN'S TRANSPORTATION SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SOUTHWEST AVE
TALLMADGE OH
44278-2230
US

IV. Provider business mailing address

175 SOUTHWEST AVE
TALLMADGE OH
44278-2230
US

V. Phone/Fax

Practice location:
  • Phone: 330-836-3485
  • Fax: 330-873-3022
Mailing address:
  • Phone: 330-836-3485
  • Fax: 330-873-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number770122
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number775015
License Number StateOH

VIII. Authorized Official

Name: SHERRI LEE MITCHEN
Title or Position: TREASURER
Credential:
Phone: 330-836-3485