Provider Demographics
NPI:1225166481
Name:CITY OF UNIVERSITY HEIGHTS
Entity Type:Organization
Organization Name:CITY OF UNIVERSITY HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:216-321-1939
Mailing Address - Street 1:2300 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3139
Mailing Address - Country:US
Mailing Address - Phone:216-321-1939
Mailing Address - Fax:216-932-8584
Practice Address - Street 1:2300 WARRENSVILLE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3139
Practice Address - Country:US
Practice Address - Phone:216-321-1939
Practice Address - Fax:216-932-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492084Medicaid
OH2492084Medicaid