Healthcare Provider Details

I. General information

NPI: 1710989173
Provider Name (Legal Business Name): CITY OF ENGLEWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W NATIONAL RD
ENGLEWOOD OH
45322-1461
US

IV. Provider business mailing address

PO BOX 392907
PITTSBURGH PA
15251-9907
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-5106
  • Fax:
Mailing address:
  • Phone: 800-962-1484
  • Fax: 513-772-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number020999550
License Number StateOH

VIII. Authorized Official

Name: ANTHONY TERRACE
Title or Position: FIRE CHIEF
Credential:
Phone: 937-836-5106