Provider Demographics
NPI:1861612368
Name:MIRACLE MEDICAL TRANSPORTATION,INC
Entity type:Organization
Organization Name:MIRACLE MEDICAL TRANSPORTATION,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHITEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-336-1646
Mailing Address - Street 1:6700 BETA DR
Mailing Address - Street 2:SUITE #118
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-336-1646
Mailing Address - Fax:440-229-5010
Practice Address - Street 1:5655-A N. GREENWAY CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-336-1646
Practice Address - Fax:440-229-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2313688Medicaid