MEDICARE: PEARL WHITE

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)
2	343900000X	Non-emergency Medical Transport (VAN)	RY084652	OH

General Provider Information

NPI Number	:	1447966882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL WHITE

Provider Business Mailing Address
First Line	:	1403 PLAINFIELD RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2513
Country	:	US
Telephone Number	:	216-217-2318
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 PLAINFIELD RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2513
Country	:	US
Telephone Number	:	216-217-2318
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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Directions to “ PEARL WHITE ” Practice Location

Language	Start Address	Practice Location

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