Healthcare Provider Details

I. General information

NPI: 1932693637
Provider Name (Legal Business Name): DAVID KILBRIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 STATE ROUTE 113 E
BERLIN HEIGHTS OH
44814-9435
US

IV. Provider business mailing address

7412 STATE ROUTE 113 E
BERLIN HEIGHTS OH
44814-9435
US

V. Phone/Fax

Practice location:
  • Phone: 216-702-4242
  • Fax: 419-588-2789
Mailing address:
  • Phone: 216-702-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: