MEDICARE: PLANET MEDICAL TRANSPORTATION LLC

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	347C00000X	Private Vehicle	DHF3896	OH

General Provider Information

NPI Number	:	1396992285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANET MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	4441 SILSBY RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3938
Country	:	US
Telephone Number	:	216-381-5858
Fax Number	:	216-381-9028

Provider Business Practice Location Address
First Line	:	4441 SILSBY RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3938
Country	:	US
Telephone Number	:	216-381-5858
Fax Number	:	216-381-9028

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS HELENA A GLAZER
Credential	:
Telephone Number	:	216-381-5858

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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