Healthcare Provider Details

I. General information

NPI: 1033352786
Provider Name (Legal Business Name): KSIM 'LLC'
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27300 EUCLID AVE APT 2
EUCLID OH
44132-3405
US

IV. Provider business mailing address

27300 EUCLID AVE APT 2
EUCLID OH
44132-3405
US

V. Phone/Fax

Practice location:
  • Phone: 216-780-3204
  • Fax:
Mailing address:
  • Phone: 216-780-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberRP928998
License Number StateOH

VIII. Authorized Official

Name: MR. MARK A DAVIS
Title or Position: OWNER
Credential:
Phone: 216-772-7187