Healthcare Provider Details

I. General information

NPI: 1396923991
Provider Name (Legal Business Name): WILLARD AREA MEDICAL ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 WOODBINE ST
WILLARD OH
44890-1635
US

IV. Provider business mailing address

740 WOODBINE ST
WILLARD OH
44890-1635
US

V. Phone/Fax

Practice location:
  • Phone: 419-935-6761
  • Fax: 419-933-1676
Mailing address:
  • Phone: 419-935-6761
  • Fax: 419-933-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34003318
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID ALLEN JUMP
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 419-935-6761