Provider Demographics
NPI:1538176698
Name:VILLAGE OF LAKEMORE
Entity type:Organization
Organization Name:VILLAGE OF LAKEMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:380-733-6125
Mailing Address - Street 1:25001 EMERY ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-831-2300
Mailing Address - Fax:216-831-4130
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEMORE
Practice Address - State:OH
Practice Address - Zip Code:44250
Practice Address - Country:US
Practice Address - Phone:330-733-6125
Practice Address - Fax:330-733-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI9252371Medicare ID - Type Unspecified