Provider Demographics
NPI:1376539437
Name:CITY OF MENTOR ON THE LAKE
Entity Type:Organization
Organization Name:CITY OF MENTOR ON THE LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PECHATSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-257-7223
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:5860 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-2827
Practice Address - Country:US
Practice Address - Phone:440-257-7216
Practice Address - Fax:440-257-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590013209OtherRAILROAD MEDICARE
OH000000155996OtherANTHEM BCBS
OH2096486Medicaid
OH=========001OtherTRICARE 4 LIFE
OH000000155996OtherANTHEM BCBS
OH=========002OtherMEDICAL MUTUAL OF OHIO
OH9299631Medicare PIN