Provider Demographics
NPI:1336350065
Name:EMERALD TRANSPORTATION
Entity Type:Organization
Organization Name:EMERALD TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-404-8911
Mailing Address - Street 1:1640 FRANKLIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4383
Mailing Address - Country:US
Mailing Address - Phone:800-404-8911
Mailing Address - Fax:330-673-7475
Practice Address - Street 1:1640 FRANKLIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4383
Practice Address - Country:US
Practice Address - Phone:800-404-8911
Practice Address - Fax:330-673-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0958736Medicaid