Organization
BRACEVILLE TOWNSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM SHAY JR. (FISCAL OFFICER)
(330) 872-0085
Entity
Organization
Contact information
Practice address
800 BRACEVILLE ROBINSON RD SW, NEWTON FALLS, OH 44444-9529
(330) 898-7199
(330) 898-1740
Mailing address
PO BOX 392907, PITTSBURGH, PA 15251-9907
(800) 962-1484
(513) 772-4464
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000155955
ANTHEM
—
05
—
0779073
—
OH
05
—
1544152
—
OH
Enumeration date
12/15/2006
Last updated
05/23/2024
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