Provider Demographics
NPI:1982720462
Name:VILLAGE OF HUNTSVILLE
Entity Type:Organization
Organization Name:VILLAGE OF HUNTSVILLE
Other - Org Name:HUNTSVILLE EMERGENCY SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-686-4294
Mailing Address - Street 1:6740 WISHART ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43324-9619
Mailing Address - Country:US
Mailing Address - Phone:937-686-4294
Mailing Address - Fax:937-686-4329
Practice Address - Street 1:6740 WISHART ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43324-9619
Practice Address - Country:US
Practice Address - Phone:937-686-4294
Practice Address - Fax:937-686-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879401Medicaid
OH0879401Medicaid