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General NPI Number Information
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NPI Number | 1699698571
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Entity Type | Organization
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Legal Business Name | BLUE WILLOW MEDICAL TRANSPORT
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 1053 OAK ST
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City | MEDINA
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State | OH
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Zip | 44256-4043
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Country | US
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Telephone | 216-765-1011
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Fax | 216-765-1011
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Provider Business Mailing Address
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Address Line | 1053 OAK ST
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City | MEDINA
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State | OH
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Zip | 44256-4043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HADIA MANDENIN FANY
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Credential | DIOP
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Telephone | 216-765-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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