Provider Demographics
NPI:1043430689
Name:CITY OF NILES
Entity Type:Organization
Organization Name:CITY OF NILES
Other - Org Name:NILES CITY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SAYERS
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-544-8011
Mailing Address - Street 1:34 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-5036
Mailing Address - Country:US
Mailing Address - Phone:330-544-9000
Mailing Address - Fax:330-544-9030
Practice Address - Street 1:34 W STATE ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-5036
Practice Address - Country:US
Practice Address - Phone:330-544-9000
Practice Address - Fax:330-544-9030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF NILES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000186397Medicaid
OH0812106Medicaid
OH0555948OtherBCMH
OH0812106Medicaid
OHFV90721Medicare ID - Type Unspecified