Provider Demographics
NPI:1790907855
Name:AMEN MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:AMEN MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIZURUOKE
Authorized Official - Middle Name:OBINNA
Authorized Official - Last Name:UDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-355-5151
Mailing Address - Street 1:4249 BLUESTONE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-355-5151
Mailing Address - Fax:
Practice Address - Street 1:4249 BLUESTONE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-355-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186795343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2720005Medicaid
OH186795OtherOHIO MEDICAL TRANSP. BOAR