1396855714 NPI number — WILLIAMS COUNTY TRANSPORT

Table of content: (NPI 1396855714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396855714 NPI number — WILLIAMS COUNTY TRANSPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMS COUNTY TRANSPORT
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:
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:
1396855714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 147
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:
43506-0147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-636-4510
Provider Business Mailing Address Fax Number:
419-636-0554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
05842 ST RT 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-636-4510
Provider Business Practice Location Address Fax Number:
419-636-0554
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
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: 0123413 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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