Provider Demographics
NPI:1083603864
Name:CITY OF BROADVIEW HEIGHTS
Entity Type:Organization
Organization Name:CITY OF BROADVIEW HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAJEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-526-4493
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:3591 E WALLINGS RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1412
Practice Address - Country:US
Practice Address - Phone:440-526-4493
Practice Address - Fax:440-526-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155958OtherANTHEM BCBS
OH0367302Medicaid
OH370590001OtherCARESOURCE
OH590007199OtherRAILROAD MEDICARE
OH346000033900OtherBUREAU OF WORKERS COMP
OH346000033900OtherBUREAU OF WORKERS COMP
OH370590001OtherCARESOURCE
OH=========OtherTRICARE 4 LIFE