Provider Demographics
NPI:1215964101
Name:VILLAGE OF BEACH CITY
Entity type:Organization
Organization Name:VILLAGE OF BEACH CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-756-2664
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44608-0695
Mailing Address - Country:US
Mailing Address - Phone:330-756-2312
Mailing Address - Fax:330-756-3199
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACH CITY
Practice Address - State:OH
Practice Address - Zip Code:44608-9319
Practice Address - Country:US
Practice Address - Phone:330-756-2664
Practice Address - Fax:330-756-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000176108OtherBCBS
OH2228404Medicaid
OH34144902700OtherBWC
OH590013867OtherRRMEDICARE
OH=========OtherTRICARE
OH2228404Medicaid
OH=========OtherTRICARE