1073509121 NPI number — SYCAMORE VILLAGE OFFICE OF CLERK

Table of content: (NPI 1073509121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073509121 NPI number — SYCAMORE VILLAGE OFFICE OF CLERK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYCAMORE VILLAGE OFFICE OF CLERK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SYCAMORE AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073509121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77
Provider Second Line Business Mailing Address:
106 E SEVENTH STREET
Provider Business Mailing Address City Name:
SYCAMORE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44882-0077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-927-2900
Provider Business Mailing Address Fax Number:
419-927-2988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 E SEVENTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-927-2900
Provider Business Practice Location Address Fax Number:
419-927-2988
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLOUSE
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
419-397-2063

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  020299904 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0259081 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590007226 . This is a "RAILROAD MEDICARE PROVIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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