MEDICARE: CITY OF EAST CLEVELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033202189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF EAST CLEVELAND

Provider Business Mailing Address
First Line	:	1822 MARLOES AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3922
Country	:	US
Telephone Number	:	216-681-2319
Fax Number	:	216-681-2098

Provider Business Practice Location Address
First Line	:	14340 EUCLID AVE
Second Line	:	ROOM 108
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3402
Country	:	US
Telephone Number	:	216-681-2319
Fax Number	:	216-681-2098

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MR. RONALD BROOKS
Credential	:
Telephone Number	:	216-681-2319

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	12/28/2007

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Directions to “CITY OF EAST CLEVELAND ” Practice Location

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