Provider Demographics
NPI:1316947567
Name:CITY OF WILLARD
Entity type:Organization
Organization Name:CITY OF WILLARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRYSON
Authorized Official - Last Name:HAMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-933-2591
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:800-926-6985
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:425 FORT BALL RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9323
Practice Address - Country:US
Practice Address - Phone:419-933-2591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1259700341600000X
OHFCY.021259700-13341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590175336OtherRAILROAD MEDICARE
OH000000156080OtherANTHEM
OH0234679Medicaid
OH9129071Medicare PIN