Provider Demographics
NPI:1083823025
Name:MEDPORT, INC
Entity type:Organization
Organization Name:MEDPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:REINHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-587-9715
Mailing Address - Street 1:PO BOX 25277
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-0277
Mailing Address - Country:US
Mailing Address - Phone:216-587-9715
Mailing Address - Fax:216-662-0052
Practice Address - Street 1:9400 MIDWEST AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-2420
Practice Address - Country:US
Practice Address - Phone:216-587-9715
Practice Address - Fax:216-662-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2243530Medicaid