MEDICARE: GOOD SHEPHERD AMBULANCE 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	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1750429221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD AMBULANCE LLC

Provider Business Mailing Address
First Line	:	3570 W 140TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2410
Country	:	US
Telephone Number	:	216-476-9200
Fax Number	:	216-476-9202

Provider Business Practice Location Address
First Line	:	3570 W 140TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2410
Country	:	US
Telephone Number	:	216-476-9200
Fax Number	:	216-476-9202

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MISS REBECCA HESTER
Credential	:
Telephone Number	:	216-240-9474

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	08/22/2020

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Directions to “GOOD SHEPHERD AMBULANCE LLC ” Practice Location

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