Provider Demographics
NPI:1396855714
Name:WILLIAMS COUNTY TRANSPORT
Entity type:Organization
Organization Name:WILLIAMS COUNTY TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-636-6751
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-0147
Mailing Address - Country:US
Mailing Address - Phone:419-636-4510
Mailing Address - Fax:419-636-0554
Practice Address - Street 1:05842 ST RT 15
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506
Practice Address - Country:US
Practice Address - Phone:419-636-4510
Practice Address - Fax:419-636-0554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAMS COUNTY COMMISSONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123413Medicaid
OH9273511Medicare ID - Type Unspecified