MEDICARE: 4M EMERGENCY SYSTEMS TOD LLC

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000385524	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1902859556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4M EMERGENCY SYSTEMS TOD LLC

Provider Business Mailing Address
First Line	:	4535 DRESSLER RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2545
Country	:	US
Telephone Number	:	330-994-4409
Fax Number	:	330-492-8489

Provider Business Practice Location Address
First Line	:	1296 TOD PL NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2474
Country	:	US
Telephone Number	:	844-474-4019
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT OFFICER
Name	:	MELISSA REESE
Credential	:
Telephone Number	:	855-687-0618

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/24/2023

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