Provider Demographics
NPI:1750370367
Name:OHIO CITY CORPORATION
Entity type:Organization
Organization Name:OHIO CITY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-965-2255
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:OHIO CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45874-0246
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:
Practice Address - Street 1:103 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:OHIO CITY
Practice Address - State:OH
Practice Address - Zip Code:45874
Practice Address - Country:US
Practice Address - Phone:419-965-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
OHFCY.021231000-13341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2215409Medicaid
OH000000197512OtherANTHEM
OH590014320OtherRAILROAD MEDICARE