Provider Demographics
NPI:1720200793
Name:CITY OF FAIRVIEW PARK
Entity Type:Organization
Organization Name:CITY OF FAIRVIEW PARK
Other - Org Name:FAIRVIEW PARK FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, DIVISION OF FIRE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-356-4424
Mailing Address - Street 1:20777 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2018
Mailing Address - Country:US
Mailing Address - Phone:440-356-4424
Mailing Address - Fax:440-356-4454
Practice Address - Street 1:20777 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2018
Practice Address - Country:US
Practice Address - Phone:440-356-4424
Practice Address - Fax:440-356-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0949077Medicaid
OH0949077Medicaid