Healthcare Provider Details

I. General information

NPI: 1962522631
Provider Name (Legal Business Name): CITY OF MACEDONIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9691 VALLEY VIEW RD
MACEDONIA OH
44056-2044
US

IV. Provider business mailing address

9691 VALLEY VIEW RD
MACEDONIA OH
44056-2044
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-8339
  • Fax: 330-468-8393
Mailing address:
  • Phone: 330-468-8339
  • Fax: 330-468-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY BLACK
Title or Position: CHIEF
Credential:
Phone: 330-468-8339