Provider Demographics
NPI:1598971046
Name:MEDICAL TRANSPORTATION ASSOCIATES LLC
Entity Type:Organization
Organization Name:MEDICAL TRANSPORTATION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:OZUEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-276-7395
Mailing Address - Street 1:17600 MILES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3406
Mailing Address - Country:US
Mailing Address - Phone:216-283-9900
Mailing Address - Fax:216-283-9903
Practice Address - Street 1:17600 MILES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3406
Practice Address - Country:US
Practice Address - Phone:216-283-9900
Practice Address - Fax:216-283-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186255343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2533459Medicaid