Provider Demographics
NPI:1962522631
Name:CITY OF MACEDONIA
Entity type:Organization
Organization Name:CITY OF MACEDONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-468-8339
Mailing Address - Street 1:9691 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2044
Mailing Address - Country:US
Mailing Address - Phone:330-468-8339
Mailing Address - Fax:330-468-8393
Practice Address - Street 1:9691 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2044
Practice Address - Country:US
Practice Address - Phone:330-468-8339
Practice Address - Fax:330-468-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2235852Medicaid
OH2235852Medicaid