Provider Demographics
NPI:1164601464
Name:PATRIOT LLC
Entity Type:Organization
Organization Name:PATRIOT LLC
Other - Org Name:PATRIOT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KUSZMAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-221-8896
Mailing Address - Street 1:585 GOLDEN OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6501
Mailing Address - Country:US
Mailing Address - Phone:216-221-8896
Mailing Address - Fax:216-221-8897
Practice Address - Street 1:585 GOLDEN OAK PKWY
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6501
Practice Address - Country:US
Practice Address - Phone:216-221-8896
Practice Address - Fax:216-221-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021770700332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2811050Medicaid
OH4487470002Medicare NSC