Provider Demographics
NPI:1376768689
Name:IDEIS TRANSPORTAION
Entity Type:Organization
Organization Name:IDEIS TRANSPORTAION
Other - Org Name:ON TIME MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:I
Authorized Official - Last Name:IDEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-244-5102
Mailing Address - Street 1:3615 SUPERIOR AVE E
Mailing Address - Street 2:SUITE 3101-E
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-4138
Mailing Address - Country:US
Mailing Address - Phone:216-244-5102
Mailing Address - Fax:216-361-9797
Practice Address - Street 1:3615 SUPERIOR AVE E
Practice Address - Street 2:SUITE 3101-E
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4138
Practice Address - Country:US
Practice Address - Phone:216-244-5102
Practice Address - Fax:216-361-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH185755343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614184Medicaid