Provider Demographics
NPI:1356404388
Name:CITY OF WADSWORTH
Entity type:Organization
Organization Name:CITY OF WADSWORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC SAFETY
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:HIVCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-335-2709
Mailing Address - Street 1:120 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281
Mailing Address - Country:US
Mailing Address - Phone:330-335-2705
Mailing Address - Fax:330-335-2711
Practice Address - Street 1:153 NORTH LYMAN STREET
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281
Practice Address - Country:US
Practice Address - Phone:330-334-2849
Practice Address - Fax:330-334-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0502165Medicaid
OHCI9196591Medicare UPIN
OHCI9196591Medicare ID - Type UnspecifiedMEDICARE PROVIDER #