Provider Demographics
NPI:1932151669
Name:CITY OF GREEN
Entity type:Organization
Organization Name:CITY OF GREEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-896-6603
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:44232-0278
Mailing Address - Country:US
Mailing Address - Phone:330-896-6603
Mailing Address - Fax:330-896-6606
Practice Address - Street 1:4200 MASSILLON ROAD
Practice Address - Street 2:
Practice Address - City:GREEN
Practice Address - State:OH
Practice Address - Zip Code:44232-0278
Practice Address - Country:US
Practice Address - Phone:330-896-6610
Practice Address - Fax:330-896-2933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF GREEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020347051341600000X
OH020347050341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155751OtherBCBS
OH590007797OtherRAILROAD MEDICARE
OH0697769Medicaid
OH590007797OtherRAILROAD MEDICARE
OH0697769Medicaid
OH=========001OtherMEDICAL MUTUAL