=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275761215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONAL LEASING TRANSPORTATION CO.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2009
-----------------------------------------------------
Last Update Date | 06/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13945 TRISKETT RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44111-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-476-3636
-----------------------------------------------------
Fax | 216-252-5658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13945 TRISKETT RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44111-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-476-3636
-----------------------------------------------------
Fax | 216-252-5658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MATTHEW E. RAWLINGS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-476-3636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 187895
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------