Organization
MECCA TOWNSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS DOMES (CHIEF)
(330) 637-3436
Entity
Organization
Contact information
Practice address
6333 STATE ROUTE 46, CORTLAND, OH 44410-9609
(330) 240-3145
Mailing address
PO BOX 392907, PITTSBURGH, PA 15251-9900
(800) 962-1484
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189250
ANTHEM BC & BS
—
05
—
0877510
—
OH
01
—
8180381
UNITED HEALTHCARE
—
Enumeration date
01/10/2007
Last updated
05/21/2024
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