=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538176698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE OF LAKEMORE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 MAIN ST
-----------------------------------------------------
City | LAKEMORE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-733-6125
-----------------------------------------------------
Fax | 330-733-3801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25001 EMERY ROAD SUITE 100
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-831-2300
-----------------------------------------------------
Fax | 216-831-4130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | CLARENCE C BITTNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 380-733-6125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------