MEDICARE: CMJW, INC. DBA KOALA KRUIZERS

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)

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	:	1518383124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMJW, INC. DBA KOALA KRUIZERS

Provider Business Mailing Address
First Line	:	1310 N MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-1977
Country	:	US
Telephone Number	:	330-966-2327
Fax Number	:	330-966-2339

Provider Business Practice Location Address
First Line	:	1170 S MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4272
Country	:	US
Telephone Number	:	330-966-2327
Fax Number	:	330-966-2339

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	RYAN THOMAS HECKERT
Credential	:
Telephone Number	:	330-204-6079

Provider Enumeration Date	:	03/07/2014
Last Update Date	:	02/17/2021

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