Provider Demographics
NPI:1528170990
Name:CITY OF CANTON
Entity type:Organization
Organization Name:CITY OF CANTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN/EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-438-4553
Mailing Address - Street 1:PO BOX 9151
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44711-9151
Mailing Address - Country:US
Mailing Address - Phone:330-489-3400
Mailing Address - Fax:330-471-8831
Practice Address - Street 1:110 7TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-2128
Practice Address - Country:US
Practice Address - Phone:330-489-3256
Practice Address - Fax:330-471-8831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CANTON FIRE DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020328050341600000X
3416L0300X
OH341600000X, 341600000X, 341600000X, 341600000X, 341600000X, 341600000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590007156OtherRR MEDICARE
OH000000155964OtherBCBS
OH802689OtherBLACK LUNG
OH0892486Medicaid
OH9251611Medicare PIN