MEDICARE: JAMAL BLAND

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	:	1902472251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMAL BLAND

Provider Business Mailing Address
First Line	:	5648 HAMLET AVE REAR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1704
Country	:	US
Telephone Number	:	216-512-4933
Fax Number	:

Provider Business Practice Location Address
First Line	:	5648 HAMLET AVE REAR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1704
Country	:	US
Telephone Number	:	216-512-4933
Fax Number	:

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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Directions to “ JAMAL BLAND ” Practice Location

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