Provider Demographics
NPI:1346292364
Name:4M EMERGENCY SYSTEMS ANDOVER LLC
Entity Type:Organization
Organization Name:4M EMERGENCY SYSTEMS ANDOVER LLC
Other - Org Name:ALTEON HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-686-2300
Mailing Address - Street 1:12420 MILESTONE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7111
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2329
Practice Address - Street 1:476 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9602
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:330-656-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000000385522OtherANTHEM
OH2622442Medicaid
OH101978995-0001OtherPENNSYLVANIA MEDICAID
OH0000000385522OtherANTHEM
OHDE8192Medicare PIN