Provider Demographics
NPI:1336141951
Name:WILLARD MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WILLARD MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JOINT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-933-2811
Mailing Address - Street 1:218 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1408
Mailing Address - Country:US
Mailing Address - Phone:419-933-2811
Mailing Address - Fax:419-933-4502
Practice Address - Street 1:218 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1408
Practice Address - Country:US
Practice Address - Phone:419-933-2811
Practice Address - Fax:419-933-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management