1316908718 NPI number — WILLIAMS COUNTY OFFICE OF AUDITOR

Table of content: (NPI 1316908718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316908718 NPI number — WILLIAMS COUNTY OFFICE OF AUDITOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMS COUNTY OFFICE OF AUDITOR
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:
Provider Other Organization Name Type Code:
6
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:
1316908718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43506-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-636-6751
Provider Business Mailing Address Fax Number:
419-636-0554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5842 STATE ROUTE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43506-8884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-636-6751
Provider Business Practice Location Address Fax Number:
419-636-0554
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRIGLE
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
KENRICK
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
419-636-6751

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000156081 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0413609 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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