MEDICARE: CITY OF MAPLE HEIGHTS

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	3416L0300X	Land Ambulance

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
2	000000155995	OTHER	OH	BLUE CROSS BLUE SHIELD
3	OTH000	OTHER	OH	AMBULANCE

General Provider Information

NPI Number	:	1154415800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MAPLE HEIGHTS

Provider Business Mailing Address
First Line	:	5520 WARRENSVILLE CENTER ROAD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3126
Country	:	US
Telephone Number	:	216-587-9093
Fax Number	:	216-587-9055

Provider Business Practice Location Address
First Line	:	5520 WARRENSVILLE CENTER ROAD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3126
Country	:	US
Telephone Number	:	216-587-9093
Fax Number	:	216-587-9055

Authorized Official
Title or Position	:	BILLING
Name	:	KATHIE DEFRANCESCO
Credential	:
Telephone Number	:	216-587-9093

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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Directions to “CITY OF MAPLE HEIGHTS ” Practice Location

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