MEDICARE: MRS. ANGELA KING

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	172A00000X	Driver
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1386814507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA KING

Provider Business Mailing Address
First Line	:	5311 NORTFIELD RD #12
Second Line	:
City	:	BEDFORD HTS.
State	:	OH
Zip	:	44146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 NORTHFIELD RD # 12
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1135
Country	:	US
Telephone Number	:	216-474-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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Directions to “ MRS. ANGELA KING ” Practice Location

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