Provider Demographics
NPI:1073509121
Name:SYCAMORE VILLAGE OFFICE OF CLERK
Entity Type:Organization
Organization Name:SYCAMORE VILLAGE OFFICE OF CLERK
Other - Org Name:SYCAMORE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-397-2063
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:106 E SEVENTH STREET
Mailing Address - City:SYCAMORE
Mailing Address - State:OH
Mailing Address - Zip Code:44882-0077
Mailing Address - Country:US
Mailing Address - Phone:419-927-2900
Mailing Address - Fax:419-927-2988
Practice Address - Street 1:106 E SEVENTH ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:OH
Practice Address - Zip Code:44849
Practice Address - Country:US
Practice Address - Phone:419-927-2900
Practice Address - Fax:419-927-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0202999043416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259081Medicaid
OH590007226OtherRAILROAD MEDICARE PROVIDE
OHW937040001Medicare UPIN
OH590007226OtherRAILROAD MEDICARE PROVIDE