Organization
WILLARD EMERGENCY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J BUNKER (CHAIRMAN/PRESIDENT/CEO)
(904) 805-1300
Entity
Organization
Contact information
Practice address
110 E HOWARD ST, WILLARD, OH 44890-1611
(419) 964-5000
(904) 805-1302
Mailing address
PO BOX 758705, BALTIMORE, MD 21275-0001
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000187190
BLUE CROSS & BLUE SHIELD
OH
01
—
020204700
FL BLACK LUNG
OH
05
—
2193335
—
OH
01
—
264363100
DEPT OF LABOR
OH
01
—
P00173421
RAIL ROAD MEDICARE
OH
Enumeration date
05/04/2006
Last updated
07/23/2008
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