MEDICARE: GLASS CITY MEDICAL TRANSPORTATION SERVICE

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)

General Provider Information

NPI Number	:	1619691763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLASS CITY MEDICAL TRANSPORTATION SERVICE

Provider Business Mailing Address
First Line	:	1732 COPLEY DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3809
Country	:	US
Telephone Number	:	567-329-7823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 COPLEY DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3809
Country	:	US
Telephone Number	:	567-329-7823
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHARAFA RABIU
Credential	:
Telephone Number	:	567-329-7823

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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Directions to “GLASS CITY MEDICAL TRANSPORTATION SERVICE ” Practice Location

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