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General NPI Number Information
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NPI Number | 1043630015
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Entity Type | Organization
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Legal Business Name | FORMFIRE, LLC
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 1360 E 9TH ST SUITE 850
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City | CLEVELAND
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State | OH
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Zip | 44114-1737
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Country | US
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Telephone | 216-357-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 E 9TH ST SUITE 850
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City | CLEVELAND
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State | OH
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Zip | 44114-1737
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Country | US
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Telephone | 216-357-7400
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER / CEO
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Name | MICHAEL EPP
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Credential |
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Telephone | 216-502-2320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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