MEDICARE: PBC TRANSPORTATION & HAULING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013481365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PBC TRANSPORTATION & HAULING LLC

Provider Business Mailing Address
First Line	:	950 WHITBY RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-2348
Country	:	US
Telephone Number	:	216-334-0494
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 WHITBY RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-2348
Country	:	US
Telephone Number	:	216-334-0494
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. TERRELL CLIFF GARDNER
Credential	:	DET, SUMMA CUM LAUDE
Telephone Number	:	216-334-0494

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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