MEDICARE: CITY WIDE WHEELCHAIR TRANSPORT

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	343900000X	Non-emergency Medical Transport (VAN)		OH

General Provider Information

NPI Number	:	1043593981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY WIDE WHEELCHAIR TRANSPORT

Provider Business Mailing Address
First Line	:	5602 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4428
Country	:	US
Telephone Number	:	216-631-4400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SALIM HASROUNI
Credential	:
Telephone Number	:	216-346-4542

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/27/2011

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