=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952664831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE MEDICAL TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2012
-----------------------------------------------------
Last Update Date | 06/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4862 KAREN ISLE DR
-----------------------------------------------------
City | RICHMOND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-825-3498
-----------------------------------------------------
Fax | 216-731-0986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4862 KAREN ISLE DR
-----------------------------------------------------
City | RICHMOND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-825-3498
-----------------------------------------------------
Fax | 216-731-0986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE
-----------------------------------------------------
Name | MR. SHAMSIDEEN OLUMIDE KAZEEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-825-3498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 188195
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------