Organization
CITY OF ASHTABULA OHIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE J BRADLEY (ADMINISTRATIVE ASSISTANT)
(440) 992-7123
Entity
Organization
Contact information
Practice address
4717 MAIN AVE, ASHTABULA, OH 44004-6943
(440) 992-7122
Mailing address
4717 MAIN AVE, ASHTABULA, OH 44004-6943
(440) 992-7123
(440) 992-7163
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0875496
—
OH
Enumeration date
02/07/2007
Last updated
06/17/2013
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