MEDICARE: EMERALD 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)		OH

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	:	1336350065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD TRANSPORTATION

Provider Business Mailing Address
First Line	:	1640 FRANKLIN AVE
Second Line	:	SUITE 200
City	:	KENT
State	:	OH
Zip	:	44240-4383
Country	:	US
Telephone Number	:	800-404-8911
Fax Number	:	330-673-7475

Provider Business Practice Location Address
First Line	:	1640 FRANKLIN AVE
Second Line	:	SUITE 200
City	:	KENT
State	:	OH
Zip	:	44240-4383
Country	:	US
Telephone Number	:	800-404-8911
Fax Number	:	330-673-7475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL BAKES
Credential	:
Telephone Number	:	800-404-8911

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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Directions to “EMERALD TRANSPORTATION ” Practice Location

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