Provider Demographics
NPI: | 1619998788 |
---|---|
Name: | BROOKPARK CITY |
Entity Type: | Organization |
Organization Name: | BROOKPARK CITY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HIGGINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 216-433-1215 |
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: | |
Practice Address - Street 1: | 17401 HOLLAND RD |
Practice Address - Street 2: | |
Practice Address - City: | BROOKPARK |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44142 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-433-1215 |
Practice Address - Fax: | 216-433-7340 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-22 |
Last Update Date: | 2024-04-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3416L0300X | Transportation Services | Ambulance | Land Transport |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 000000155962 | Other | ANTHEM BCBS |
OH | 2079692 | Medicaid | |
OH | 000000155962 | Other | ANTHEM BCBS |