Provider Demographics
NPI:1841391398
Name:UNIFIED SYSTEMS
Entity Type:Organization
Organization Name:UNIFIED SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-2871
Mailing Address - Street 1:4635 RICHMOND RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5980
Mailing Address - Country:US
Mailing Address - Phone:216-595-3602
Mailing Address - Fax:216-595-3603
Practice Address - Street 1:4635 RICHMOND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5980
Practice Address - Country:US
Practice Address - Phone:216-595-3602
Practice Address - Fax:216-595-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18494048332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2662060Medicaid