=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285314799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EZ RHODES TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2023
-----------------------------------------------------
Last Update Date | 12/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11841 SUMMERS RD
-----------------------------------------------------
City | CHESTERLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44026-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-376-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 103
-----------------------------------------------------
City | NOVELTY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44072-0103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-376-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE RHODES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-376-1888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------