=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538393087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING SIMPLY TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2009
-----------------------------------------------------
Last Update Date | 05/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12103 UNION AVE.
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-623-9148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3707 AVONDALE RD
-----------------------------------------------------
City | WOODMERE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-623-9148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHARLES E SMITH JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-623-9148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------