Provider Demographics
NPI:1699091538
Name:PRICE, ANNA MAE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MAE
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11313 TEMBLETT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2666
Mailing Address - Country:US
Mailing Address - Phone:216-326-1865
Mailing Address - Fax:216-268-5768
Practice Address - Street 1:11313 TEMBLETT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2666
Practice Address - Country:US
Practice Address - Phone:216-326-1865
Practice Address - Fax:216-268-5768
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH27-2302336343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)