MEDICARE: DIVERSITY MEDICAL 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	261QA0006X	Ambulatory Fertility Facility	258075	OH

General Provider Information

NPI Number	:	1205114634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSITY MEDICAL TRANSPORTATION

Provider Business Mailing Address
First Line	:	3167 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3606
Country	:	US
Telephone Number	:	614-263-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3167 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3606
Country	:	US
Telephone Number	:	614-263-4000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAREEM ABDIRAHMAN
Credential	:
Telephone Number	:	614-263-4000

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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Directions to “DIVERSITY MEDICAL TRANSPORTATION ” Practice Location

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