Provider Demographics
NPI:1003252537
Name:MEDICARE TRANSPORT INC
Entity Type:Organization
Organization Name:MEDICARE TRANSPORT INC
Other - Org Name:MEDICORE TRANSPORT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-706-4407
Mailing Address - Street 1:6100 OAK TREE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2544
Mailing Address - Country:US
Mailing Address - Phone:877-706-4407
Mailing Address - Fax:216-370-3245
Practice Address - Street 1:6100 OAK TREE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2544
Practice Address - Country:US
Practice Address - Phone:877-706-4407
Practice Address - Fax:216-370-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1812480343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2907AFHOtherOHIO DEPARTMENT OF MENTAL HEALTH
OH2942552Medicaid
OH1812480OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES