Provider Demographics
NPI:1992500375
Name:KING, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12278 COOPERS RUN
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-9238
Mailing Address - Country:US
Mailing Address - Phone:216-314-3562
Mailing Address - Fax:
Practice Address - Street 1:12278 COOPERS RUN
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-9238
Practice Address - Country:US
Practice Address - Phone:216-314-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUZ721136172A00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5554354OtherAMERICAN SAFETY AND HEALTH INSTITUTE BASIC LIFE SUPPORT CERTIFICATION
OHE3735769OtherNATIONAL EMS CERTIFICATION - EMT
OH0194283OtherEMERGENCY MEDICAL TECHNICIAN OHIO CERTIFICATION