Provider Demographics
NPI:1770774911
Name:DIVERSIFIED TRANSPORTATION SERVICES
Entity type:Organization
Organization Name:DIVERSIFIED TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHUNNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-867-2555
Mailing Address - Street 1:7300 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9412
Mailing Address - Country:US
Mailing Address - Phone:419-867-2555
Mailing Address - Fax:419-535-6447
Practice Address - Street 1:2852 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-1534
Practice Address - Country:US
Practice Address - Phone:419-535-0000
Practice Address - Fax:419-535-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH48-529-5343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2793795Medicaid