MEDICARE: BLACK & RED TRANSPORTATION

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)

General Provider Information

NPI Number	:	1073341764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK & RED TRANSPORTATION

Provider Business Mailing Address
First Line	:	2340 NEBRASKA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3527
Country	:	US
Telephone Number	:	419-467-9806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 NEBRASKA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3527
Country	:	US
Telephone Number	:	419-467-9806
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KETAAN WYATT SR.
Credential	:
Telephone Number	:	419-467-9806

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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Directions to “BLACK & RED TRANSPORTATION ” Practice Location

Language	Start Address	Practice Location

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