Healthcare Provider Details

I. General information

NPI: 1073509121
Provider Name (Legal Business Name): SYCAMORE VILLAGE OFFICE OF CLERK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E SEVENTH ST
SYCAMORE OH
44849
US

IV. Provider business mailing address

PO BOX 77 106 E SEVENTH STREET
SYCAMORE OH
44882-0077
US

V. Phone/Fax

Practice location:
  • Phone: 419-927-2900
  • Fax: 419-927-2988
Mailing address:
  • Phone: 419-927-2900
  • Fax: 419-927-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number020299904
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN CLOUSE
Title or Position: CHIEF
Credential:
Phone: 419-397-2063